Expandable inter-body device, system and method

ABSTRACT

The present disclosure provides for spinal implants deployable between a contracted position and an expanded position. The spinal implant may include a first endplate and a second endplate, each having a plurality of guide walls and inclined ramps. The spinal implant may further include a moving mechanism having first and second trolleys configured to act against the first and second plurality of ramps. The expansion mechanism may further include a first set screw and a second set screw opposite the first set screw. The moving mechanism may be configured to operably adjust a spacing between the first and second endplates upon simultaneous rotation of the first and second set screws along a rotation axis, and may also operably adjust an angle of inclination between the first and second endplates upon rotating the first set screw or second set screw along the rotation axis.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application hereby claims priority to and incorporates by referenceco-related patent applications, PCT/FR2020/000257, titled ExpandableInter-Body Device, System, and Method, filed Nov. 5, 2020;PCT/FR2020/000259, titled Screwdriver and Complimentary Screws, filedNov. 5, 2020; and PCT/FR2020/000258, titled Expandable Inter-BodyDevice, System, and Method, filed Nov. 5, 2020. The contents of each arehereby incorporated in their entireties.

FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to asurgical device that includes an expandable spinal implant, systems forimplanting and manipulating the expandable spinal implant, and a methodfor treating a spine.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvatureabnormalities, kyphosis, tumor, and fracture may result from factorsincluding trauma, disease and degenerative conditions caused by injuryand aging. Spinal disorders typically result in symptoms including pain,nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, they may fail to relieve the symptomsassociated with these disorders. Surgical treatment of these spinaldisorders includes fusion, fixation, correction, discectomy, laminectomyand implantable prosthetics. As part of these surgical treatments,spinal constructs, such as, for example, bone fasteners, spinal rods andinterbody devices can be used to provide stability to a treated region.For example, during surgical treatment, interbody devices may beintroduced to a space between adjacent vertebral bodies (the interbodyspace) to properly space the vertebral bodies and provide a receptaclefor bone growth promoting materials, e.g., grafting.

More recently, interbody devices have been introduced that provideadditional capability beyond static spacing of the vertebral bodies. Forexample, some devices have expansion capability such that the implantmay be introduced to the interbody space in a collapsed state and thenexpanded to produce additional spacing and, in some cases, introduce orrestore curvature to the spine by expanding selectively. However, manyexisting expandable interbody designs have limited ranges of expansion.

An additional problem exists related to subsidence of spinal surfacesdue to existing interbody devices having inadequately-sized load-bearingsurfaces. In the case of expandable devices, the loads on theload-bearing surfaces, including loads generated during expansion of theimplant, are often significant. An expandable implant with relativelylarge surface areas is needed to bear the loads, including the loadsgenerated during implant expansion, in an attempt to avoid a need forfollow-on surgery due to subsidence of spinal surfaces.

A further problem is instability of existing expandable interbodydevices as they are expanded. Often, the load-bearing surfaces moverelative to one another, as well as relative to an inserter, as theinterbody device is expanded such that there is a risk of undesiredshifts in the positioning of the interbody device within theintervertebral space. Additionally, and depending at least partly on theparticular insertion technique employed, anatomical features such as theiliac crest and rib cage pose challenges to the adjustment of inter-bodydesigns in situ.

The present disclosure seeks to address these and other shortcomings inthe existing relevant arts.

SUMMARY

The techniques of this disclosure generally relate to highly adjustableinterbody devices that are expandable to selectively increase/decrease aspacing distance between endplates of the interbody device andadjustable to selectively increase/decrease an angle of inclinationbetween endplates of the interbody device.

In one aspect, the present disclosure provides an expandable spinalimplant deployable between a contracted position and an expandedposition. The spinal implant may include a first endplate, where thefirst endplate further includes a first outside surface and a firstinside surface opposite the first outside surface, the first insidesurface including a first plurality of guide walls, a first proximal endand a first distal end opposite the first proximal end, first proximalramps and first distal ramps disposed opposite the first proximal ramps,and a first lateral surface and a second lateral surface opposite thefirst lateral surface, and the first and second lateral surfaces mayextend between the first proximal end and the first distal end. Thespinal implant may also include a second endplate, where the secondendplate further includes a second outside surface and a second insidesurface opposite the second outside surface, the second inside surfaceincluding a second plurality of guide walls, a second proximal end and asecond distal end opposite the second proximal end, second proximalramps and second distal ramps disposed opposite the second proximalramps, and a third lateral surface and a fourth lateral surface oppositethe third lateral surface, and the third and fourth lateral surfaces mayextend between the second proximal end and the second distal end. Thespinal implant may further include a moving mechanism operably coupledto the first endplate and the second endplate and positionedtherebetween. The moving mechanism may further include a buttress blockand a first trolley and a second trolley disposed on opposite sides ofthe buttress block, a screw guide wall housing a rotatable first setscrew and a rotatable second set screw opposite the first set screw, thefirst set screw being operably coupled to the first trolley and thesecond set screw being operably coupled to the second trolley. The firstset screw and second set screw may be operably configured to rotate in afirst rotation direction and a second rotation direction about arotation axis where the rotation axis projects in a longitudinaldirection of the moving mechanism. In some embodiments, the firsttrolley is operably coupled to the first set screw and movable towardand away the buttress block in the longitudinal direction of the movingmechanism by rotation of the first set screw along the rotation axis,and the second trolley is operably coupled to the second set screw andmovable toward and away the buttress block in the longitudinal directionof the moving mechanism by rotation of the second set screw along therotation axis. The first trolley may further include a first sidesurface and a second side surface opposite the first side surface andinclude a first plurality of projections projecting from the first andsecond side surfaces. The second trolley may further include a thirdside surface and a fourth side surface opposite the third side surfaceand further include a second plurality of projections projecting fromthe third and fourth side surfaces. The first and second plurality ofprojections may correspond to a cross sectional shape of the first andsecond plurality of guide walls and may be operably coupled thereto,respectively, such that the first and second plurality of projectionsmove along the first and second plurality of guide walls, respectively.In some embodiments, the moving mechanism may be configured to operablyadjust a spacing between the first and second endplates uponsimultaneous rotation of the first and second set screws along therotation axis, and the moving mechanism may be configured to operablyadjust an angle of inclination between the first and second endplatesupon rotating the first set screw or second set screw along the rotationaxis.

In another aspect, the present disclosure provides for a movingmechanism that is further configured to increase a first distancebetween the first endplate and the moving mechanism and also increase asecond distance between the second endplate and the moving mechanism anequal amount upon simultaneous rotation of the first and second setscrews in the first rotation direction. Additionally, the movingmechanism may decrease the first distance between the first endplate andthe moving mechanism and also decrease the second distance between thesecond endplate and the moving mechanism an equal amount uponsimultaneous rotation of the first and second set screws in the secondrotation direction. Furthermore, the moving mechanism may increase theangle of inclination between the first and second endplates uponrotating at least one of the first set screw or second set screw alongthe rotation axis in the first direction, and may also decrease theangle of inclination of the first and second endplates upon rotating atleast one of the first set screw or second set screw along the rotationaxis in the first direction.

In another aspect, the present disclosure provides that the firstproximal ramps may include a first and second ramp disposed adjacent thefirst proximal end that project away from the first inside surface. Thefirst distal ramps may include a third and fourth ramp disposed adjacentthe first distal end that project away from the first inside surface,the second proximal ramps may include a fifth and sixth ramp disposedadjacent the second proximal end that project away from the secondinside surface, and the second distal ramps include a seventh and eighthramp disposed adjacent the second distal end that project away from thesecond inside surface.

In another aspect, the present disclosure provides that the firsttrolley may further include a first wedge projecting from the first sidesurface in a transverse direction of the moving mechanism and a secondwedge projecting from the second side surface in the transversedirection of the moving mechanism, and the second trolley may furtherinclude a third wedge projecting from the third side surface in thetransverse direction of the moving mechanism and a fourth wedgeprojecting from the fourth side surface in the transverse direction ofthe moving mechanism.

In another aspect, the present disclosure provides that the first wedgemay include a first upper contact surface and a first lower contactsurface, the second wedge may include a second upper contact surface anda second lower contact surface, the third wedge may include a thirdupper contact surface and a third lower contact surface, the fourthwedge may include a fourth upper contact surface and a fourth lowercontact surface. Additionally, the first and second upper contactsurfaces may contact the first proximal ramps and the first and secondlower contact surfaces may contact the second proximal ramps, the thirdand fourth upper contact surfaces may contact the first distal ramps andthe third and fourth lower contact surfaces may contact the seconddistal ramps.

In another aspect, the present disclosure provides that the first wedgemay include a first curved upper contact surface and a first curvedlower contact surface, the second wedge may include a second curvedupper contact surface and a second curved lower contact surface, thethird wedge may include a third curved upper contact surface and a thirdcurved lower contact surface, and the fourth wedge may include a fourthcurved upper contact surface and a fourth curved lower contact surface.Additionally, the first and second curved upper contact surfaces maycontact the first proximal ramps and the first and second curved lowercontact surfaces may contact the second proximal ramps, and the thirdand fourth curved upper contact surfaces may contact the first distalramps and the third and fourth curved lower contact surfaces may contactthe second distal ramps. Furthermore, the first through fourth curvedupper surfaces and the first through fourth curved lower surfaces areconfigured to facilitate adjustment of the angle of inclination betweenthe first and second endplates upon rotating the first set screw alongthe rotation axis by enabling the respective curved surfaces to pivot ona corresponding ramp of the first and second proximal ramps and firstand second distal ramps.

In another aspect, the present disclosure provides that the first andsecond wedges are configured to move along first and second inclinedcontact surfaces of the first and second proximal ramps, respectively,and the third and fourth wedges are configured to move along third andfourth inclined contact surfaces of the third and fourth distal ramps,respectively.

In another aspect, the present disclosure provides that the firstinclined contact surfaces of the first proximal ramps are inclined withrespect to the first inside surface of the first endplate and extendaway from the first inside surface by a first inclined distance and thesecond inclined contact surfaces of the second proximal ramps areinclined with respect to the second inside surface of the secondendplate and extend away from the second inside surface by a secondinclined distance. Additionally, the third inclined contact surfaces ofthe first distal ramps may be inclined with respect to the first insidesurface of the first endplate and extend away from the first insidesurface by a third inclined distance and the fourth inclined contactsurfaces of the second distal ramps may be inclined with respect to thesecond inside surface of the second endplate and extend away from thesecond inside surface by a second inclined distance. Furthermore, thefirst inclined distance may be greater than the third inclined distanceand the second inclined distance may be greater than the fourth inclineddistance thereby facilitating adjustment of the angle of inclinationbetween the first and second endplates upon rotating the first set screwalong the rotation axis.

In another aspect, the present disclosure provides that each ramp of thefirst and second proximal ramps and first and second distal rampsincludes a corresponding contact surface, and each guide wall of thefirst plurality of guide walls and each guide wall of the secondplurality of guide walls extends in a parallel direction with at leastone ramp of the first and second proximal ramps and first and seconddistal ramps.

In another aspect, the present disclosure provides that the first andsecond endplates are pivotable in a lateral direction thereof withrespect to the moving mechanism.

In another aspect, the present disclosure provides that the first andsecond endplates may include a plurality of grafting surfaces configuredto promote bone growth therebetween.

In another aspect, the present disclosure provides that the first andsecond endplates may include a plurality of inclined apertures and acorresponding plurality of anchoring screws, each anchoring screwpassing through a corresponding inclined aperture and being configuredto anchor into a vertebral body.

In another aspect, the present disclosure provides that the screw guidewall housing includes an aperture passing through the first proximal endof the first endplate and the second proximal end of the secondendplate, the aperture being configured to receive a correspondingsurgical tool having circumferential edges extending in a longitudinaldirection thereof. Additionally, the circumferential edges may beconfigured to selectively engage with the first set screw and second setscrew in a first insertion position, and engage with only the second setscrew in a second insertion position. Furthermore, the correspondingsurgical tool may be configured to selectively rotate the first andsecond set screws along the rotation axis.

In another aspect, the present disclosure provides that the screw guidewall housing is further configured to receive the corresponding surgicaltool at an offset angle with respect to the rotation axis of the movingmechanism.

In another aspect, the present disclosure provides that the first andsecond endplates each have a footprint configured for at least onesurgical technique chosen from: anterior surgical insertion andadjustment techniques, oblique surgical insertion and adjustmenttechniques, and lateral surgical insertion and adjustment techniques.

In another aspect, the present disclosure provides that the movingmechanism may be configured to: adjust the spacing between the first andsecond endplates at the proximal end from about 10 mm to about 22 mm andadjust the spacing between the first and second endplates at the distalend from about 7 mm to about 12 mm; and adjust the angle of inclinationbetween the first and second endplates within an angular range fromabout 7° to about 25°.

In another aspect, the present disclosure provides that the movingmechanism may be configured to adjust the spacing between the first andsecond endplates at the proximal end from about 9 mm to about 16 mm andadjust the spacing between the first and second endplates at the distalend from about 9 mm to about 16 mm, and may also adjust the angle ofinclination between the first and second endplates within an angularrange from about 6° to about 11°.

In another aspect, the present disclosure provides that the firstendplate has a concave surface profile with respect to the movingmechanism and the second endplate has a convex surface profile withrespect to the moving mechanism.

In another aspect, the present disclosure provides for an interbodydevice deployable between a contracted position and an expandedposition. The interbody device may include a spinal implant, the spinalimplant having a longitudinal axis and a transverse axis perpendicularto the longitudinal axis, a proximal end and a distal end disposed onopposite ends of the transverse axis, and first and second lateralsurfaces disposed on opposite ends of the longitudinal axis. The spinalimplant may include: a first endplate, where the first endplate includesa first plurality of guide walls and a first plurality of inclinedramps, where each guide wall of the first plurality of guide wallsextends along an inside surface of the first endplate in a directionparallel to a contact surface of a corresponding inclined ramp of thefirst plurality of inclined ramps. The spinal implant may also include:a second endplate, the second endplate including a second plurality ofguide walls and a second plurality of inclined ramps, each guide wall ofthe second plurality of guide walls extends along an inside surface ofthe second endplate in a direction parallel to a contact surface of acorresponding inclined ramp of the second plurality of inclined ramps.The spinal implant may further include a moving mechanism operablycoupled to the first endplate and the second endplate and positionedtherebetween. The moving mechanism may further include: a first trolleyand a second trolley disposed opposite the first trolley, the first andsecond trolleys having a plurality of projections and a plurality ofwedges, where each projection may be configured to move along acorresponding guide wall of the first and second plurality of guidewalls and each wedge may be configured to contact and move along acorresponding ramp of the first and second plurality of ramps. Theexpansion mechanism may further include a first set screw and a secondset screw opposite the first set screw, the first set screw beingoperably coupled to the first trolley and the second set screw beingoperably coupled to the second trolley, the first set screw and secondset screw may be configured to rotate in a first direction and a seconddirection about a rotation axis, the rotation axis projecting in alongitudinal direction of the moving mechanism in a parallel directionof the transverse axis of the spinal implant. The moving mechanism mayfurther include an adjustment aperture exposing internal circumferentialsurfaces of the first and second screws, respectively. Additionally, thefirst screw may be configured to move the first trolley in thelongitudinal direction of the moving mechanism by rotation of the firstscrew along the rotation axis and the second screw may be configured tomove the second trolley in the longitudinal direction of the movingmechanism by rotation of the second set screw along the rotation axis.The moving mechanism may be configured to operably adjust a spacingbetween the first and second endplates upon simultaneous rotation of thefirst and second set screws along the rotation axis, and may alsooperably adjust an angle of inclination between the first and secondendplates upon rotating the first set screw or second set screw alongthe rotation axis.

In another aspect, the present disclosure provides for a spinal implantsystem adjustable in situ between vertebral bodies of a patient anddeployable between a contracted position and an expanded position. Thesystem may include a spinal implant having a longitudinal axis and atransverse axis perpendicular to the longitudinal axis, a proximal endand a distal end disposed on opposite ends of the transverse axis, andfirst and second lateral surfaces disposed on opposite ends of thelongitudinal axis, the spinal implant may include: a first endplate,where the first endplate may include a first plurality of guide wallsand a first plurality of inclined ramps, where each guide wall of thefirst plurality of guide walls extends along an inside surface of thefirst endplate in a direction parallel to a contact surface of acorresponding inclined ramp of the first plurality of inclined ramps.The spinal implant may further include: a second endplate, the secondendplate including a second plurality of guide walls and a secondplurality of inclined ramps, where each guide wall of the secondplurality of guide walls extends along an inside surface of the secondendplate in a direction parallel to a contact surface of a correspondinginclined ramp of the second plurality of inclined ramps. The spinalimplant may further include a moving mechanism operably coupled to thefirst endplate and the second endplate and positioned therebetween, themoving mechanism may further include: a first trolley and a secondtrolley disposed opposite the first trolley, the first and secondtrolleys may have a plurality of projections and a plurality of wedges,each projection may be configured to move along a corresponding guidewall of the first and second plurality of guide walls and each wedge maybe configured to contact and move along a corresponding ramp of thefirst and second plurality of ramps. The moving mechanism may furtherinclude a first set screw and a second set screw opposite the first setscrew, the first set screw being operably coupled to the first trolleyand the second set screw being operably coupled to the second trolley,the first set screw and second set screw may be configured to rotate ina first direction and a second direction about a rotation axis, therotation axis projecting in a longitudinal direction of the movingmechanism in a parallel direction of the transverse axis of the spinalimplant. The moving mechanism may further include an adjustment apertureexposing internal circumferential surfaces of the first and secondscrews. The system may further include a first surgical tool having acircumferential surface that corresponds to the internal circumferentialsurfaces of the first and second screws, the first surgical tool beingconfigured to selectively rotate the first screw when inserted thereinand rotate the first and second screws when inserted therein.Additionally, the first screw may be configured to move the firsttrolley in the longitudinal direction of the moving mechanism byrotation of the first screw along the rotation axis and the second screwmay be configured to move the second trolley in the longitudinaldirection of the moving mechanism by rotation of the second set screwalong the rotation axis. Furthermore, the moving mechanism may beconfigured to operably adjust a spacing between the first and secondendplates upon simultaneous rotation of the first and second set screwsalong the rotation axis, and the moving mechanism may be configured tooperably adjust an angle of inclination between the first and secondendplates upon rotating the first set screw or second set screw alongthe rotation axis.

The details of one or more aspects of the disclosure are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the techniques described in this disclosurewill be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A is a perspective view of one embodiment of an expandable spinalimplant in a fully contracted position in accordance with the principlesof the present disclosure;

FIG. 1B is an exploded parts view of the embodiment of FIG. 1A inaccordance with the principles of the present disclosure;

FIG. 1C is a perspective view of one embodiment of an expandable spinalimplant in a contracted or closed configuration in accordance with theprinciples of the present disclosure;

FIG. 1D is a perspective view of one embodiment of an expandable spinalimplant in an expanded or opened configuration in accordance with theprinciples of the present disclosure;

FIGS. 2A and 2B are a top down views of the embodiment of FIGS. 1A and1B in accordance with the principles of the present disclosure;

FIGS. 2C and 2D are side views of the embodiment of FIGS. 1A and 1B in acontracted position in accordance with the principles of the presentdisclosure;

FIGS. 2E and 2F are side views of the embodiment of FIGS. 1A and 1B inan expanded position in accordance with the principles of the presentdisclosure;

FIG. 3A is a perspective view of one embodiment of an expandable spinalimplant in a closed configuration in accordance with the principles ofthe present disclosure;

FIG. 3B is a perspective view of one embodiment of an expandable spinalimplant in an expanded configuration in accordance with the principlesof the present disclosure;

FIG. 4A is a top down view of the embodiment of FIGS. 2A-2C inaccordance with the principles of the present disclosure;

FIG. 4B is a side view of the embodiment of FIGS. 2A-2C in a contractedposition in accordance with the principles of the present disclosure;

FIG. 4C is a side view of the embodiment of FIGS. 2A-2C in a partiallyexpanded and inclined position in accordance with the principles of thepresent disclosure;

FIG. 4D is a side view of the embodiment of FIGS. 2A-2C in a fullyexpanded position in accordance with the principles of the presentdisclosure;

FIG. 5A is a top down view of one embodiment in accordance with theprinciples of the present disclosure;

FIG. 5B is a front side view of the embodiment of FIG. 5A in accordancewith the principles of the present disclosure;

FIG. 5C is an alternate side view of the embodiment of FIG. 5A inaccordance with the principles of the present disclosure;

FIGS. 6A-6C are top down views of three exemplary footprint sizes of atop endplate in accordance with the principles of the presentdisclosure;

FIGS. 7A-7C are top down views of three exemplary footprint sizes of abottom endplate in accordance with the principles of the presentdisclosure;

FIG. 8 is perspective view of one embodiment of an expandable spinalimplant system in accordance with the principles of the presentdisclosure;

FIG. 9A is a cutout perspective showing a surgical tool in a firstadjustment position where an exemplary spinal implant is in a contractedposition;

FIG. 9B is a cutout perspective showing the surgical tool in the firstadjustment position after adjusting the exemplary spinal implant fromthe contracted position to a first expanded position;

FIG. 10A is a cutout perspective showing the surgical tool in a secondadjustment position where the exemplary spinal implant is in the firstexpanded position of FIG. 9B;

FIG. 10B is a cutout perspective showing the surgical tool in the secondposition after adjusting the exemplary spinal implant from the firstexpanded position to an expanded and angled position;

FIGS. 11A and 11B are perspective views of a moving mechanism in acontracted position and an expanded position, respectively, inaccordance with the principles of the present disclosure;

FIGS. 12A and 12B are perspective views of the moving mechanism of FIGS.11A and 11B in the contracted position and the expanded position,respectively, with a bottom endplate in accordance with the principlesof the present disclosure;

FIGS. 13A and 13B are perspective views of the moving mechanism of FIGS.12A and 12B in the contracted position and the expanded position,respectively, with a top endplate and the bottom endplate in accordancewith the principles of the present disclosure;

FIGS. 14A and 14B are cut-out views of a moving mechanism in accordancewith the principles of the present disclosure;

FIG. 15 is a cross section of the moving mechanism of FIGS. 14A and 14Balong a longitudinal axis thereof in accordance with the principles ofthe present disclosure;

FIG. 16 is a perspective view of a top endplate and bottom endplate ofone embodiment of an expandable spinal implant in accordance with theprinciples of the present disclosure;

FIG. 17 is an exploded view of the top endplate and bottom endplate ofFIG. 16 in accordance with the principles of the present disclosure;

FIGS. 18A-18B are perspective views of a first surgical tool of anexpandable spinal implant system in accordance with the principles ofthe present disclosure;

FIGS. 19A-19C are side views of first surgical tool and adjustment rodof an expandable spinal implant system, respectively, in accordance withthe principles of the present disclosure;

FIG. 20 illustrates a perspective view of one embodiment of anexpandable spinal implant system having anchoring screws in accordancewith the principles of the present disclosure;

FIGS. 21A-21B illustrate a lateral side view and front side view,respectively, of one embodiment of an expandable spinal implant systemhaving anchoring screws in accordance with the principles of the presentdisclosure;

FIG. 22A is a side view of a second surgical device suitable for usewith the embodiment of FIG. 20 in accordance with the principles of thepresent disclosure;

FIG. 22B is a side view of an enlarged region of FIG. 22A in accordancewith the principles of the present disclosure;

FIGS. 23A-23C are various perspective views of exemplary anchoringscrews suitable for use with the embodiment of FIG. 20 in conjunctionwith the second surgical tool of FIGS. 22A-22B in accordance with theprinciples of the present disclosure;

FIGS. 24A-24D are various side views and top down views of exemplarybone grafts in accordance with the principles of the present disclosure;

FIG. 25A and FIG. 25B illustrate a first bent position and a second bentposition, respectively, of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIGS. 26-28 illustrate a left side view, right side view, and front sideview, respectively, of an installed expandable spinal implant positionedbetween adjacent vertebral bodies in accordance with the principles ofthe present disclosure;

FIG. 29A is a perspective view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 29B is an exploded view of the embodiment of FIG. 29A in accordancewith the principles of the present disclosure;

FIG. 30A is a top down view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 30B is perspective view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 30C is a perspective view of one embodiment of an expandable spinalimplant with a top endplate removed in accordance with the principles ofthe present disclosure;

FIG. 30D is an alternate perspective view of one embodiment of anexpandable spinal implant with a top endplate removed in accordance withthe principles of the present disclosure;

FIG. 30E is a top down view of one embodiment of a top endplate inaccordance with the principles of the present disclosure;

FIG. 30F is a top down view of one embodiment of a bottom endplate inaccordance with the principles of the present disclosure;

FIG. 31 is a perspective view of one embodiment of an expandable spinalimplant system illustrating three alternate angular positions of aninsertion tool in accordance with the principles of the presentdisclosure;

FIG. 32A is a top down view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 32B is a perspective view of the embodiment of FIG. 32A inaccordance with the principles of the present disclosure;

FIG. 33A is a perspective view of one embodiment of an expandable spinalimplant in accordance with the principles of the present disclosure;

FIG. 33B is a perspective view of the embodiment of FIG. 33A in anexpanded position in accordance with the principles of the presentdisclosure;

FIG. 33C is a perspective view of the embodiment of FIG. 33A in a firsttilted position in accordance with the principles of the presentdisclosure;

FIG. 33D is a perspective view of the embodiment of FIG. 33A in a secondtilted position in accordance with the principles of the presentdisclosure;

FIG. 34 is a perspective view of one embodiment of an expandable spinalimplant system in accordance with the principles of the presentdisclosure;

FIG. 35 is a perspective view of one embodiment of an expandable spinalimplant system illustrating three alternate angular positions of aninsertion tool in accordance with the principles of the presentdisclosure;

FIG. 36 is a perspective view of one embodiment of an expandable spinalimplant including a screw guide endplate having at least one apertureconfigured to receive a anchoring screw therein;

FIG. 37 is a front view of the embodiment of FIG. 36 ;

FIGS. 38A and 38B are various perspective views of a screw guideendplate having at least one aperture configured to receive a anchoringscrew therein;

FIGS. 39A and 39B are top down view of a top endplate and a bottomendplate including at least one slotted aperture configured to receive aanchoring screw therein;

FIG. 40 is a perspective view of one embodiment of an expandable spinalimplant including a screw guide endplate having at least one apertureconfigured to receive a anchoring screw therein;

FIG. 41 is a front view of the embodiment of FIG. 40 ;

FIG. 42A is a front views of a screw guide endplate having at least oneaperture configured to receive a anchoring screw therein;

FIG. 42B is a front view of the screw guide endplate of FIG. 42Aincluding anchoring screws installed in each of the correspondingapertures;

FIG. 43A and FIG. 43B are various perspective views of a screw guideendplate having at least one aperture configured to receive a anchoringscrew therein;

FIGS. 44A and 44B are top down views of a top endplate and a bottomendplate including at least one recessed portion configured toaccommodate a anchoring screw; and

FIG. 45 is a reference diagram illustrating various cardinal directionsand planes with respect to a patient that the exemplary embodiments ofFIGS. 1-44B may operate, adjust, and/or move along in accordance withthe principles of the present disclosure.

DETAILED DESCRIPTION

The exemplary embodiments of, for example, an anterior expandableinter-body device, lateral expandable inter-body device, inter-bodydevice systems, and inter-body device methods of use are discussed interms of medical devices for the treatment of musculoskeletal disordersand more particularly, in terms of various inter-body devices suitableas spinal implants for anterior surgical techniques, oblique surgicaltechniques, and lateral surgical techniques. Exemplary embodiments arealso discussed with related emphasis on specialized adjustmentinstruments such as, for example, an instrument capable of adjusting aspacing of the aforementioned various interbody devices between adjacentvertebrates of a spine by expansion and contraction as well as adjustingan angle of inclination with respect to the coronal plane and/orsagittal plane of a patient. Disclosed devices and systems may becapable of adjusting the curvature of a patient's spine for lordosiscorrection and a kyphosis correction. Likewise, an instrument capable ofinstalling various anchoring screws is described in conjunction withdisclosed inter-body devices.

As used herein, standard anatomical terms of location have theirordinary meaning as they would be understood by a person of ordinaryskill in the art unless clearly defined or explained otherwise. Itshould be understood that various aspects disclosed herein may becombined in different combinations than the combinations specificallypresented in the description and accompanying drawings. For example,characteristics of one embodiment may be combined or substituted withcharacteristics of another different embodiment unless thosecharacteristics are clearly explained as being mutually exclusive. Itshould also be understood that, depending on the example, certain actsor events of any of the processes or methods described herein may beperformed in a different sequence, may be added, merged, or left outaltogether (e.g., all described acts or events may not be necessary tocarry out the disclosed techniques and methods). In addition, whilecertain aspects of this disclosure are described as being performed by asingle module or unit for purposes of clarity, it should be understoodthat the techniques of this disclosure may be performed by a combinationof units or modules associated with, for example, a medical device.

In some embodiments, the present system includes an expandable spinalimplant suitable for insertion for oblique techniques, postero-lateralprocedures and/or transforaminal lumbar interbody fusions (sometimesreferred to as TLIF procedures), direct posterior (sometimes referred toas PLIF procedures), direct lateral (sometimes referred to as DLIFprocedures), anterior lumbar interbody fusions (sometimes referred to asALIF procedures), or variations of these procedures, in which thepresent implant is inserted into an intervertebral space and thenexpanded in order to impart and/or augment a lordotic and/or kyphoticcurve of the spine.

In some embodiments, the spinal implant system may also be employed torestore and/or impart sagittal balance to a patient by increasing and/orrestoring an appropriate lordotic and/or kyphotic angle betweenvertebral bodies at a selected level where the spinal implant isimplanted and expanded. Additionally, some embodiments may also beemployed to restore and/or impart coronal balance for correction of, forexample, scoliosis. In the various embodiments described, the spinalimplant system may be useful in a variety of complex spinal proceduresfor treating spinal conditions beyond one-level fusions. Furthermore,the spinal implant system described in the enclosed embodiments may alsobe used as a fusion device with an expandable height for tailoring theimplant to a particular interbody disc space to restore the spacingbetween adjacent vertebral bodies and facilitate spinal fusion betweenthe adjacent vertebral bodies.

In some embodiments, and as mentioned above, the present disclosure maybe employed to treat spinal disorders such as, for example, degenerativedisc disease, disc herniation, osteoporosis, spondylolisthesis,stenosis, scoliosis and other curvature abnormalities, kyphosis, tumorand fractures. In some embodiments, the present disclosure may beemployed with other osteal and bone related applications, includingthose associated with diagnostics and therapeutics. In some embodiments,the disclosed spinal implant system may be alternatively employed in asurgical treatment with a patient in a prone or supine position, and/oremploy various surgical approaches to the spine, including anterior,posterior, posterior mid-line, direct lateral, postero-lateral oblique,and/or antero lateral oblique approaches, and in other body regions. Thepresent disclosure may also be alternatively employed with proceduresfor treating the lumbar, cervical, thoracic, sacral and pelvic regionsof a spinal column. The spinal implant system of the present disclosuremay also be used on animals, bone models and other non-livingsubstrates, such as, for example, in training, testing anddemonstration.

The present disclosure may be understood more readily by reference tothe following detailed description of the embodiments taken inconnection with the accompanying drawing figures, which form a part ofthis disclosure. It is to be understood that this application is notlimited to the specific devices, methods, conditions or parametersdescribed and/or shown herein, and that the terminology used herein isfor the purpose of describing particular embodiments by way of exampleonly and is not intended to be limiting. In some embodiments, as used inthe specification and including the appended claims, the singular forms“a,” “an,” and “the” include the plural, and reference to a particularnumerical value includes at least that particular value, unless thecontext clearly dictates otherwise. Ranges may be expressed herein asfrom “about” or “approximately” one particular value and/or to “about”or “approximately” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. It isalso understood that all spatial references, such as, for example,horizontal, vertical, top, upper, lower, bottom, left and right, are forillustrative purposes only and can be varied within the scope of thedisclosure. For example, the references “upper” and “lower” are relativeand used only in the context to the other, and are not necessarily“superior” and “inferior”. Generally, similar spatial references ofdifferent aspects or components, e.g., a “proximal end” of an end plateand a “proximal end” of a wedge, indicate similar spatial orientationand/or positioning, i.e., that each “proximal end” is situated on ordirected towards the same end of the device. Further, the use of variousspatial terminology herein should not be interpreted to limit thevarious insertion techniques or orientations of the implant relative tothe positions in the spine.

As used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs, biologics,bone grafts (including allograft, autograft, xenograft, for example) orbone-growth promoting materials to a patient (human, normal or otherwiseor other mammal), employing implantable devices, and/or employinginstruments that treat the disease, such as, for example,micro-discectomy instruments used to remove portions bulging orherniated discs and/or bone spurs, in an effort to alleviate signs orsymptoms of the disease or condition. Alleviation can occur prior tosigns or symptoms of the disease or condition appearing, as well asafter their appearance. Thus, treating or treatment includes preventingor prevention of disease or undesirable condition (e.g., preventing thedisease from occurring in a patient, who may be predisposed to thedisease but has not yet been diagnosed as having it). In addition,treating or treatment does not require complete alleviation of signs orsymptoms, does not require a cure, and specifically includes proceduresthat have only a marginal effect on the patient. Treatment can includeinhibiting the disease, e.g., arresting its development, or relievingthe disease, e.g., causing regression of the disease. For example,treatment can include reducing acute or chronic inflammation;alleviating pain and mitigating and inducing re-growth of new ligament,bone and other tissues; as an adjunct in surgery; and/or any repairprocedure. Also, as used in the specification and including the appendedclaims, the term “tissue” includes soft tissue, ligaments, tendons,cartilage and/or bone unless specifically referred to otherwise. Theterm “bone growth promoting material” as used herein may include, but isnot limited to: bone graft (autograft, allograft, xenograft) in avariety of forms and compositions (including but not limited tomorselized bone graft); osteoinductive material such as bonemorphogenetic proteins (BMP) (including but not limited to INFUSE®available from Medtronic) and alternative small molecule osteoinductivesubstances; osteoconductive materials such as demineralized bone matrix(DBM) in a variety of forms and compositions (putty, chips, bagged(including but not limited to the GRAFTON® family of products availablefrom Medtronic)); collagen sponge; bone putty; ceramic-based voidfillers; ceramic powders; and/or other substances suitable for inducing,conducting or facilitating bone growth and/or bony fusion of existingbony structures. Such bone growth promoting materials may be provided ina variety of solids, putties, liquids, colloids, solutions, or otherpreparations suitable for being packed or placed into or around thevarious implants 100, 200, 300 and embodiments described herein.

The components of the expandable spinal implant systems described hereincan be fabricated from biologically acceptable materials suitable formedical applications, including metals, synthetic polymers, ceramics andbone material and/or their composites. For example, the components ofexpandable spinal implant system, individually or collectively, can befabricated from materials such as stainless steel alloys, commerciallypure titanium, titanium alloys, Grade 5 titanium, super-elastic titaniumalloys, cobalt-chrome alloys, stainless steel alloys, superelasticmetallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUMMETAL®), ceramics and composites thereof such as calcium phosphate(e.g., SKELITE™), thermoplastics such as polyaryletherketone (PAEK)including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) andpolyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO4 polymericrubbers, polyethylene terephthalate (PET), fabric, silicone,polyurethane, silicone-polyurethane copolymers, polymeric rubbers,polyolefin rubbers, hydrogels, semi-rigid and rigid materials,elastomers, rubbers, thermoplastic elastomers, thermoset elastomers,elastomeric composites, rigid polymers including polyphenylene,polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone materialincluding autograft, allograft, xenograft or transgenic cortical and/orcorticocancellous bone, and tissue growth or differentiation factors,partially resorbable materials, such as, for example, composites ofmetals and calcium-based ceramics, composites of PEEK and calcium basedceramics, composites of PEEK with resorbable polymers, totallyresorbable materials, such as, for example, calcium based ceramics suchas calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite(HA)-TCP, calcium sulfate, or other resorbable polymers such aspolyaetide, polyglycolide, polytyrosine carbonate, polycaprolactone andtheir combinations.

Various components of spinal implant system may be formed or constructedof material composites, including but not limited to the above-describedmaterials, to achieve various desired characteristics such as strength,rigidity, elasticity, compliance, biomechanical performance, durabilityand radiolucency or imaging preference. The components of expandablespinal implant system, individually or collectively, may also befabricated from a heterogeneous material such as a combination of two ormore of the above-described materials. The components of the expandablespinal implant systems may be monolithically formed, integrallyconnected or include fastening elements and/or instruments, as describedherein. For example, in some embodiments the expandable spinal implantsystems may comprise expandable spinal implants 100, 200, 300 comprisingPEEK and/or titanium structures with radiolucent markers (such astantalum pins and/or spikes) selectively placed in the implant toprovide a medical practitioner with placement and/or sizing informationwhen the expandable spinal implant 100, 200, 300 is placed in the spine.The components of the expandable spinal implant system may be formedusing a variety of subtractive and additive manufacturing techniques,including, but not limited to machining, milling, extruding, molding,3D-printing, sintering, coating, vapor deposition, and laser/beammelting. Furthermore, various components of the expandable spinalimplant system may be coated or treated with a variety of additives orcoatings to improve biocompatibility, bone growth promotion or otherfeatures. For example, the endplates 110, 120, may be selectively coatedwith bone growth promoting or bone ongrowth promoting surface treatmentsthat may include, but are not limited to: titanium coatings (solid,porous or textured), hydroxyapatite coatings, or titanium plates (solid,porous or textured).

The expandable spinal implant system may be employed, for example, witha minimally invasive procedure, including percutaneous techniques,mini-open and open surgical techniques to deliver and introduceinstrumentation and/or one or more spinal implants at a surgical sitewithin a body of a patient, for example, a section of a spine. In someembodiments, the expandable spinal implant system may be employed withsurgical procedures, as described herein, and/or, for example,corpectomy, discectomy, fusion and/or fixation treatments that employspinal implants to restore the mechanical support function of vertebrae.In some embodiments, the expandable spinal implant system may beemployed with surgical approaches, including but not limited to:anterior lumbar interbody fusions (ALIF), posterior lumbar interbodyfusion (PLIF), oblique lumbar interbody fusion, transforaminal lumbarinterbody fusion (TLIF), various types of anterior fusion procedures,and any fusion procedure in any portion of the spinal column (sacral,lumbar, thoracic, and cervical, for example).

Generally in FIGS. 1-44B, five exemplary embodiments of an expandablespinal implants 100, 200, 300, 600, and 700 are shown (spinal implant100 is highlighted in exemplary FIGS. 1-28 , implant 200 is highlightedin exemplary FIGS. 29-31 , implant 300 is highlighted in exemplary FIGS.32-35 , implant 600 is highlighted in exemplary FIGS. 36-39B, implant700 is highlighted in FIGS. 40-44B). Exemplary embodiments of surgicaltools 400, 450, and 500 are highlighted in exemplary FIGS. 8, 18-23C anddisclosed in conjunction with an inter-body spinal implant system. Forexample, surgical tools 400, 450, and 500 are discussed concurrentlywith exemplary spinal implant 100. It shall be understood that the sameor similar surgical tools highlighted in exemplary FIGS. 8, 18-23C maybe employed with expandable spinal implants 200, 300, 600, and 700.Similar and/or identical numbering of corresponding elements may be usedinterchangeably between the various exemplary embodiments of anexpandable spinal implants 100, 200, 300, 600, and 700 for ease ofunderstanding and convenience in explanation. For example, movingmechanism 250 is predominately discussed concurrently with exemplaryspinal implant 100 and is highlighted in exemplary FIGS. 9A-15 althoughthe same or similar moving mechanism 250 may be employed with expandablespinal implants 200, 300, 600, and 700. FIG. 45 is provided solely as areference illustration showing a patient 1 and various standard medicalterms and orientations with respect to cardinal directions and planes ofthe body of patient 1 in which expandable spinal implants 100, 200, 300,600, and 700 may act.

Referring generally to FIGS. 1-28 a first exemplary expandable spinalimplant 100, moving mechanism 250, first surgical tool 400, and secondsurgical tool 500 are illustrated. Spinal implant 100 may be configuredto be inserted in an intervertebral disc space between adjacentvertebral bodies accordingly to a variety of surgical techniques, e.g.,anterior techniques, oblique techniques, and lateral techniques.

FIG. 1A shows the spinal implant 100 in a perspective view and FIG. 1Bshows the spinal implant 100 in an exploded parts view. Exemplary spinalimplant 100 includes a top endplate 110 (first endplate) and a bottomendplate 120 (second endplate) and a moving mechanism 250, which will bedescribed in greater detail below. Spinal implant 100 includes aproximal end 101 and a distal end 102 opposite the proximal end 101, anda first lateral end 103 and a second lateral end 104 opposite the firstlateral end 103. The first and second lateral ends 103, 104 extendbetween the proximal end 101 and the distal end 102. The proximal end101 includes an exposed screw guide endplate 105 defining acorresponding screw guide aperture 107, which are disposed betweenendplates 110 and 120. The screw guide endplate 105 and guide aperture107 will be described in greater detail below.

Top endplate 110 may include a first outside surface 111 and a firstinside surface 112 opposite the first outside surface 111. Similarly,bottom endplate 120 may include a second outside surface 121 and asecond inside surface 122. The outside surfaces 111, 121 may beconfigured to be positioned between and/or contact vertebral bodies in apatients spine and have various surface characteristics. For example, insome embodiments, outside surfaces 111 and 122 may have a substantiallylinear surface profiles extending across faces of textured surfacesthereof. In other embodiments, outside surfaces 111 and 122 may havecurved surface profiles extending across faces of textured surfacesthereof. Further details of endplates 110, 120 will be described ingreater detail below. Inside surfaces 111, 122, may surround movingmechanism 250 and have various contours, guides, cavities, and otheroperable characteristics that facilitate movement and/or providemechanical advantage to other operable and movable corresponding partsto facilitate contraction, angular adjustment, lateral bending,absorption of compression forces, shear forces, etc. as will beexplained in greater detail below.

In the exemplary embodiment, top endplate 110 includes a pair of firstproximal ramps 114 and a pair of first distal ramps 116 opposite thefirst proximal ramps 114. Each ramp of the first proximal ramps 114includes an inclined surface extending away from inside surface 112 andmoving mechanism 250. Similarly, each ramp of first distal ramps 116includes an inclined surface extending away from inside surface 112 andmoving mechanism 250. Bottom endplate 120 includes a pair of secondproximal ramps 124 and a pair of second distal ramps 126 opposite thesecond proximal ramps 124. Each ramp of the second proximal ramps 124includes an inclined surface extending away from inside surface 122 andmoving mechanism 250. Similarly, each ramp of second distal ramps 126includes an inclined surface extending away from inside surface 112 andmoving mechanism 250. Furthermore, each ramp 114, 116, 124, 126 includesa corresponding guide wall 130 extending along an inside surface thereofand extending in a direction substantially parallel to the inclinedsurface of the corresponding ramp.

Exemplary spinal implant 100 includes a moving mechanism 250 that isoperably coupled to top endplate 110 and bottom endplate 120 as will beexplained in greater detail below. Moving mechanism 250 includes a firstset screw 252 and a corresponding first trolley 256 operably coupledthereto, and a second set screw 254 and a corresponding second trolley258 operably coupled thereto. A first functional feature of movingmechanism 250 is that it is further configured to increase and decreasea spacing between the top and bottom endplates 110, 120 uponsimultaneous rotation of the first and second set screws 252, 254 in aclockwise and counterclockwise direction, respectively. A secondfunctional feature of moving mechanism 250 is that it is furtherconfigured to increase and decrease an angle of inclination between thetop and bottom endplates 110, 120 upon rotation of the first set screw252 in a clockwise and counterclockwise direction, respectively.Additional functions and attributes of moving mechanism 250 will bedescribed in greater detail below.

FIG. 1C is a perspective view of spinal implant 100 in a contractedposition and FIG. 1D is a perspective view of spinal implant 100 in anexpanded position. In the contracted position of FIG. 1C, top endplate110 and bottom endplate 120 are contracted to a fully closed position.In the expanded position of FIG. 1B, top endplate 110 and bottomendplate 120 are expanded to a mid-way position, i.e., endplates 110 and120 can additionally expand if desired. In some embodiments, topendplate 110 may be referred to as an anterior wedge or anteriorendplate and bottom endplate 120 may be referred to as a posterior wedgeor posterior endplate.

As explained above, spinal implant 100 includes a proximal end 101 and adistal end 102 opposite the proximal end 101, and a first lateral end103 and a second lateral end 104 opposite the first lateral end 103. Itshall be understood that reference to other parts of spinal implant 100may be in terms of the above orientation with reference to spinalimplant 100 generally, e.g., endplate 110 may also include a proximalend 101 and a distal end 102 opposite the proximal end 101, and a firstlateral end 103 and a second lateral end 104 opposite the first lateralend 103.

FIGS. 2A and 2B illustrate a top down view of spinal implant 100. Spinalimplant 100 has a length L and a width W predominately defined by afootprint of endplates 110, 120. Spinal implant 100 has a firstreference axis A₁ and a second reference axis A₂. First reference axisA₁ may be understood as a projection passing through a central portionof guide aperture 107 in a direction parallel to an end surface of firstand second lateral ends 103, 104, e.g., first reference axis A₁ may passthrough the center of spinal implant 100 in a width wise direction.Second reference axis A₂ may be understood as a projection intersectingfirst reference axis A₁ and passing through the center of spinal implant100 in a length wise direction. Top endplate 110 may have a plurality ofchannels 111 c spaced apart from one another and extending in a lengthwise direction thereof, e.g., in a direction parallel with referenceaxis A₂. Similarly, bottom endplate 120 may have a plurality of channels122 c spaced apart from one another and extending in a length wisedirection thereof, e.g., in a direction parallel with reference axis A₂.In the exemplary embodiment, channels 111 c, 122 c may each have aninclined edge portion that assists with positioning the spinal implant100 between vertebral bodies and provides a surface for promoting bonegrowth thereon.

FIGS. 2C and 2D illustrate spinal implant 100 in a side view in acontracted position and FIGS. 2E and 2F illustrate spinal implant 100 ina side view in an expanded position. It shall be understood that FIGS.2C-2F schematically illustrate spinal implant 100 with some internalparts being illustrated or simplified and others being omit for ease ofexplanation. For example, FIGS. 2C-2F are illustrated schematicallysolely to assist in explaining various positions of first and secondendplates 110, 120 with respect to one another. In the contractedposition, a first height H_(1A) of proximal end 101 may be about 10 mmand in the expanded position a second height H_(1B) of proximal end 101may be about 22 mm. In the contracted position, a first height H_(2A) ofdistal end 102 may be about 7 mm and in the expanded position a secondheight H_(2B) of distal end 102 may be about 12 mm. Additionally, in thecontracted position, a first angle of inclination θ₁ between endplates110, 120 may be about 7° and in the expanded position a second angle ofinclination θ₂ between endplates 110, 120 may be about 25°. Althoughspecific ranges are provided herein with reference to exemplary spinalimplant 100, other embodiments may have alternate correspondingdimensions, i.e., height, from those provided above. Likewise, otherembodiments may have alternate corresponding angles of inclinationbetween endplates 110, 120.

FIGS. 3A and 3B are perspective view of an alternate embodiment of asecond spinal implant 200. Spinal implant 200 may have the samecharacteristics or similar characteristics as spinal implant 100. Asillustrated, spinal implant 200 includes a top patterned endplate 110 aand a bottom patterned endplate 120 a. Top patterned endplate 110 aincludes an outside surface 111 and an inside surface 112 opposite theoutside surface 111. Similarly, bottom patterned endplate 120 a includesa first outside surface 121 and a first inside surface 122 opposite theoutside surface 111. As illustrated, the outside surface 111 includes aplurality of raised diamond shaped surfaces 111 d (a diamond treadpattern) and a plurality of first openings 111 a that may each have adiamond like shape, a circular shape, and/or a diamond like shapeincluding chamfered or rounded corners. Although not visible in FIGS. 3Aand 3B, it shall be understood that bottom patterned endplate 120 a mayalso have a plurality of raised diamond shaped surfaces and a pluralityof openings the same as or similar to the plurality of raised diamondshaped surfaces 111 d and the plurality of first openings 111 a of toppatterned endplate 110 a.

As illustrated, the plurality of first openings 111 a are circular anddisposed in a central region of top patterned endplate 110 a, althoughthey may have alternate shapes and/or be disposed in alternate locationsin other embodiments. For example, first and second outside surfaces 111and 122 may comprise various anti-migration, anti-expulsion, and/orosseointegration features including, but not limited to: ridges, teeth,pores, and coatings (including but not limited to porous titaniumcoatings such as those provided on Capstone PTCTM implants availablefrom Medtronic). The endplates 110 a, 120 a may further comprise atleast one second opening 115 defined therein, and configured to allowbone growth materials to be packed, placed, or loaded into spinalimplant 200. In the exemplary embodiment a pair of second openings 115are shown with each having a D like shape.

FIG. 4A illustrates spinal implant 200 in a top down view and each ofFIGS. 4B-4D illustrate spinal implant 200 in a side view in a differentrespective position. FIG. 4B illustrates spinal implant 200 in a firstposition, FIG. 4C illustrates spinal implant 200 in a second positionand FIG. 4D illustrates spinal implant 200 in a third position. In thefirst position, a first height H_(1A) of proximal end 101 may be about10 mm, in the second position a second height H_(1B) of proximal end 101may be about 18 mm, and in the third position a third height H_(1C) ofproximal end 101 may be about 18 mm. In the first position, a firstheight H_(2A) of distal end 102 may be about 6 mm, in the secondposition a second height H_(2B) of distal end 102 may be about 5 mm, andin the third position a third height H_(1C) of distal end 102 may beabout 11.8 mm (approximately 12 mm). Additionally, in the firstposition, a first angle of inclination θ₁ between endplates 110 a, 120 amay be about 9°, in the second position a second angle of inclination θ₂between endplates 110 a, 120 a may be about 30°, and in the thirdposition a third angle of inclination θ₃ between endplates 110 a, 120 amay be about 13°. In some embodiments, the first position may correspondto a fully contracted position, the second position may correspond to amaximum inclination angle, and the third position may correspond to afully expanded position. Although specific ranges are provided hereinwith reference to exemplary spinal implant 100, other embodiments mayhave alternate corresponding dimensions, i.e., height, from thoseprovided above. Likewise, other embodiments may have alternatecorresponding angles of inclination between endplates 110 a, 120 a.

FIG. 5A is a top down view of a spinal implant 300. Spinal implant 300may have the same characteristics or similar characteristics as spinalimplant 200 and spinal implant 100. FIGS. 5B and 5C are alternate sideviews of the embodiment of FIG. 5A. As illustrated spinal implant 300includes a first reference axis A₁ and a second reference axis A₂. Firstreference axis A₁ passes through the center of spinal implant 300 in awidth wise direction and second reference axis A₂ passes through thecenter of spinal implant 300 in a length wise direction. First andsecond reference axes A₁ and A₂ may be understood as linear projectionsthat are perpendicular with respect to one another. Additionally, firstreference axis A₁ may pass through the center of guide aperture 107 andother components operably disposed therein, e.g., moving mechanism 250as will be discussed in greater detail below.

As illustrated, spinal implant 300 includes a top curved endplate 110 cand a bottom curved endplate 120 c. The top curved endplate 110 cfeatures a concave surface profile with respect to the first and secondreference axes A₁ and A₂ projecting thereunder. The concave surfaceprofile is emphasized by the curved line thereabove. The bottom curvedendplate 120 features a convex surface profile with respect to the firstand second reference axes A₁ and A₂ projecting thereabove. The convexsurface profile is emphasized by the curved line therebelow.

FIGS. 6A-6C are top down views of three exemplary footprint sizes of afirst top endplate 110 x, second top endplate 110 y, and third topendplate 110 z. It shall be understood that first, second, and third topendplates 110 x, 110 y, and 110 z may be substituted for endplates 110,110 a, and 110 c in accordance with the principles of the presentdisclosure. FIGS. 7A-7C are top down views of three exemplary footprintsizes of a first bottom endplate 120 x, second bottom endplate 120 y,and third bottom endplate 120 z. It shall be understood that first,second, and third bottom endplates 120 x, 120 y, and 120 z may besubstituted for endplates 120, 120 a, and 120 c in accordance with theprinciples of the present disclosure. First top endplate 110 x and firstbottom endplate 120 x may have a length of about 32 mm and a width ofabout 25 mm. Second top endplate 110 y and second bottom endplate 120 ymay have a length of about 37 mm and a width of about 29 mm. Third topendplate 110 z and third bottom endplate 120 z may have a length ofabout 42 mm and a width of about 32 mm. It shall be understood thatfirst top endplate 110 x and first bottom endplate 110 y are suitablefor patients with relatively small vertebrae, second top endplate 110 yand second bottom endplate 110 y are suitable for patients withrelatively larger vertebrae than the previous example, and third topendplate 110 z and third bottom endplate 110 z are suitable for patientswith relatively larger vertebrae than the previous two examples. In thisway, spinal implants 100, 200, and 300 may be configured to have any ofthe exemplary footprint sizes explained above depending on a particularpatient's vertebral anatomy. For example, as part of an initialassessment a surgeon may assess which of the available footprint sizesis best suited for a particular patient's vertebral anatomy. It shall beunderstood that the above exemplary footprint sizes are non-limitingexemplary embodiments and that other footprint sizes may be used withany of spinal implants 100, 200, 300 provided the chosen footprint sizeis suitable for a particular patient's anatomy. However, the threeexemplary footprint sizes explained above are generally suitable for themajority of patients.

FIG. 8 is a perspective view of one embodiment of an expandable spinalimplant system 1000 in accordance with the principles of the presentdisclosure. First surgical tool 400 includes a handle 402, shaft 404,tip 406, locking mechanism 408, and adjustment knob 452. Tip 406 isconfigured to be inserted inside of guide aperture 107 and operablyconnected to spinal implant 100. First surgical tool 400 is configuredto perform a variety of functions for operably manipulating spinalimplant 100. For example, first surgical tool 400 is configured tooperably engage with spinal implant 100 via a secured connection suchthat a spinal implant 100 may be inserted between vertebral bodies of apatient according to anterior surgical techniques, oblique surgicaltechniques, and lateral surgical techniques. Additionally, firstsurgical tool 400 is configured to operably engage with spinal implant100 to adjust spinal implant 100 from a contracted position to anexpanded position and vice-versa. Furthermore, first surgical tool 400is configured to operably engage with spinal implant 100 to adjust anangle of inclination between endplates 110, 120. Further still, spinalimplant 100 may be adjusted in situ between vertebral bodies afterspinal implant 100 is inserted into a patient. Additional attributes ofthe surgical tool will be disclosed below with reference to FIGS.18A-19B

FIG. 9A is a cutout perspective showing first surgical tool 400 in afirst adjustment position where the spinal implant 100 is in acontracted position and FIG. 9B is a cutout perspective showing firstsurgical tool 400 in the first adjustment position after adjusting thespinal implant 100 from the contracted position to a first expandedposition. As illustrated, tip 406 is inserted through guide aperture 107and into moving mechanism 250. Moving mechanism 250 includes a first setscrew 252 and a second set screw 254 having respective internal cavitiesconfigured to operably receive tip 406. In some embodiments, first setscrew 252 may be referred to as an anterior screw and second set screw254 may be referred to as a posterior screw. The first and second setscrews 252, 254 have a helical thread pitch that corresponds to keyedprojections of first and second trolleys 256, 258, respectively. In theexemplary embodiment, the second set screw 254 has a reverse threadpitch and a shorter length than first set screw 252. In someembodiments, the thread pitch may be an M6 thread pitch, however otherembodiments may have other thread pitches.

Each internal cavity of set screws 252, 254 comprises an internalcircumferential surface that is keyed to the outside circumferentialsurface 456 of tip 406 of first surgical tool 400. For example, theoutside circumferential surface 456 may resemble the geometry of the tipof a torx driver, hex driver, or the like and the internalcircumferential surfaces of the first and second set screws 252, 254 mayresemble the geometry of the cavity of the head of a torx screw, hexscrew, or the like. In some embodiments, the internal circumferentialsurfaces of the first and second set screws 252, 254 may be configuredfor a Torx T20 driver or the like, however other embodiments may bedifferently sized. In other embodiments, the connection between theouter circumferential surface 456 and the inner circumferential surfacesof first and second set screws 252, 254 may comprise a variety of driveinterfaces including but not limited to: multi-lobular drives;hexalobular drives; cross or Phillips head drives; straight or “flathead” drives; square or other polygonal drives; and/or combinationsthereof. It shall be understood that any suitable geometrical shape orsurface profile may be used by the exemplary embodiments disclosedherein provided the outside circumferential surface 456 is operablykeyed to engage with the internal circumferential surfaces of the firstand second set screws 252, 254.

In the exemplary embodiment, outside circumferential surface 456 isengaged with both the first and second set screws 252, 254 and whenfirst surgical tool 400 is rotated in a first direction (clockwisedirection) the outside circumferential surface 456 translates both setscrews 252, 254 thereby causing the first and second trolleys 256, 258to move away from one another in opposite directions. In turn, the firstand second trolleys 256, 258 cause the top and bottom endplates 110, 120to move apart from one another an equal amount in the expansiondirection indicated by the arrows. The expansion direction may be agenerally vertical direction projecting away from and perpendicular tothe generally horizontal direction of a rotation axis of the movingmechanism. Likewise, when first surgical tool 400 is rotated in a seconddirection (counter-clockwise direction) the outside circumferentialsurface 456 translates both set screws 252, 254 thereby causing thefirst and second trolleys 256, 258 to move towards one another (notillustrated). In turn, the first and second trolleys 256, 258 urge thetop and bottom endplates 110, 120 to move towards one another an equalamount in a contraction direction (not illustrated). The contractiondirection may be a generally vertical direction projecting towards andperpendicular to the generally horizontal direction of the rotation axisof the moving mechanism. In summary, when positioning the first surgicaltool 400 in the first position and rotating the first surgical tool 400in either the first or second direction the moving mechanism 250operably adjusts a spacing between the top and bottom endplates bysimultaneous rotation of the first and second set screws 252, 254 alongthe rotation axis.

FIG. 10A is a cutout perspective showing first surgical tool 400 in asecond adjustment position where the spinal implant 100 is in the firstexpanded position of FIG. 9B. As illustrated, first surgical tool 400 isretracted from moving mechanism 250 such that the outsidecircumferential surface 456 is only engaged with the first set screw252, i.e., first surgical tool 400 is in the second position. When firstsurgical tool 400 is in the second position and rotated in a firstdirection (clockwise direction) the outside circumferential surface 456translates only the first set screw 252 thereby causing only the firsttrolley 256 to move towards the proximal end 101 of spinal implant 100and allowing the second trolley 258 to remain stationary in place. Inturn, the first trolley 256 urges the proximal end 101 of top and bottomendplates 110, 120 thereby causing top and bottom endplates 110, 120 tomove apart from one another at the proximal end 101 in the directionshown by the arrows thereby increasing an angle of inclination betweenthe top and bottom endplates 110, 120. Likewise, when first surgicaltool 400 is in the second position and is rotated in the seconddirection (counter-clockwise direction) the outside circumferentialsurface 456 translates only the first set screw 252 thereby causing thefirst trolley 256 to move towards the stationary second trolley 258. Ineffect, the top and bottom endplates 110, 120 move towards one anotherat the proximal end 101 (not illustrated) thereby decreasing an angle ofinclination between the top and bottom endplates 110, 120. In summary,when positioning the first surgical tool 400 in the second position androtating the first surgical tool 400 in either the first or seconddirection the moving mechanism 250 operably adjusts an angle ofinclination between the top and bottom endplates 110, 120 upon rotatingthe first set screw along the rotation axis.

FIGS. 11A and 11B are perspective views of a moving mechanism 250 in acontracted position and an expanded position, respectively. Movingmechanism 250 is suitable for use in any exemplary embodiments disclosedherein. As illustrated moving mechanism 250 includes a screw guidehousing 105 a coupled to screw guide endplate 105 (not illustrated) anda central buttress block 257. Screw guide housing 105 a may operablyretain first and second screws 252, 254 therein and thereby define arotation axis of moving mechanism 250 projecting in a longitudinaldirection thereof. First and second trolleys 256, 258 are operablycoupled to first and second set screws 252, 254 and are furtherconfigured to move along outside surfaces of screw guide housing 105 aupon rotation of first and second set screws 252, 254.

First trolley 256 includes a first beveled edge 256 a and a secondbeveled edge 256 b opposite the first beveled edge 256 a, the first andsecond beveled edges 256 a, 256 b are disposed on opposite sides of therotation axis of the moving mechanism 250. Second trolley 258 includes athird beveled edge 258 a and a fourth beveled edge 258 b (notillustrated) opposite the third beveled edge 258 a, the third and fourthbeveled edges 258 a, 258 b are disposed on opposite sides of therotation axis of the moving mechanism 250. Additionally, first trolley256 has a first side surface and a second side surface opposite thefirst side surface, the first and second side surfaces being on oppositesides of the rotation axis of the moving mechanism 250. Likewise, secondtrolley 256 has a third side surface and a fourth side surface oppositethe third side surface, the third and fourth side surfaces being onopposite sides of the rotation axis of the moving mechanism 250.Furthermore, buttress block 257 has a seventh and eighth side surfaceopposite the seventh side surface, the seventh and eighth side surfacesbeing on opposite sides of the rotation axis of the moving mechanism250.

First trolley 256 includes a first plurality of projections 256 c, thesecond trolley 258 includes a second plurality of projections 258 c, andthe buttress block 257 includes a third plurality of projections 257 c.In the exemplary embodiment, first trolley 256 has two projections 256 cprojecting perpendicularly out from first side surface and twoprojections 256 c projecting perpendicularly out from second sidesurface. Likewise, second trolley 258 has two projections 258 cprojecting perpendicularly out from third side surface and twoprojections 258 c projecting perpendicularly out from fourth side.Furthermore, buttress block 257 has two projections 257 c projectingperpendicularly out from seventh side surface and two projections 258 cprojecting perpendicularly out from eighth side surface. The first andsecond plurality of projections 256 c, 258 c may be conically shapedprojections having a dome like shape or a hemispherical shape, forexample. In the non-limiting exemplary embodiment, each projection ofthe first and second plurality of projections 256 c, 258 c comprises ahemispherical projection having a flat surface that coincides with acorresponding surface of one of the first through fourth beveled edges256 a, 256 b, 258 a, 258 b. However, other embodiments may have othershapes and/or surface profiles as may be consistent with the disclosureherein.

First trolley 256 includes a first plurality of wedges 256 d and secondtrolley 258 includes a second plurality of wedges 258 d. For example,first trolley 256 includes a first wedge 256 d projecting away from thefirst side surface in a transverse direction of the moving mechanism 250and a second wedge 256 d projecting away from the second side surface inthe transverse direction of the moving mechanism. Likewise, secondtrolley 258 includes a third wedge 258 d projecting away from the thirdside surface in a transverse direction of the moving mechanism 250 and afourth wedge 258 d projecting away from the fourth side surface in thetransverse direction of the moving mechanism. In the exemplaryembodiment, each wedge of the first plurality of wedges 256 d includes acorresponding upper contact surface 256 e and a corresponding lowercontact surface 256 f and each respective upper contact surface 256 emeets a corresponding lower contact surface 256 f at an apex point (notlabeled). Likewise each wedge of the second plurality of wedges 258 dincludes a corresponding upper contact surface 258 e and a correspondinglower contact surface 258 f and each respective upper contact surface258 e meets a corresponding lower contact surface 258 f at an apex point(not labeled). In the exemplary embodiment, each upper contact surface256 e, 258 e and each lower contact surface 256 f, 258 f has a curvedsurface profile. For example, each upper contact surface 256 e, 258 e isconcave with respect to a corresponding apex point and each lowercontact surface 256 f, 258 f is convex with respect to a correspondingapex point.

FIGS. 12A and 12B are perspective views of moving mechanism 250 of FIGS.11A and 11B in the contracted position and the expanded position,respectively, shown with an exemplary bottom endplate 120. FIGS. 13A and13B are perspective views of the moving mechanism 250 of FIGS. 12A and12B in the contracted position and the expanded position, respectively,with a top endplate 110 and a bottom endplate 120. It shall beunderstood that FIGS. 12A-13B schematically moving mechanism 250 withsome internal parts being illustrated or simplified and others beingomit for ease of explanation. For example, FIGS. 12A-13B are illustratedschematically solely to assist in explaining operable characteristics ofmoving mechanism 250. FIGS. 12A and 12B show bottom endplate 120 havinga pair of second proximal ramps 124 and a pair of second distal ramps126 disposed opposite the pair of second proximal ramps 124. Each rampof second proximal ramps 124 may include a first inclined contactsurface 124 a extending away from buttress block 257 and inclined withrespect to an inside surface 122 of endplate 120. Similarly, each rampof second distal ramps 126 may include a second inclined contact surface126 a extending away from buttress block 257 and inclined with respectto an inside surface 122 of endplate 120. In the exemplary embodiment,the first inclined contact surfaces extend a first length (firstdistance) and the second inclined contact surfaces extend a secondlength (second distance) and the first length is greater than the secondlength.

FIGS. 13A and 13B show top endplate 110 having a pair of first proximalramps 114 and a pair of first distal ramps 116 disposed opposite thepair of first proximal ramps 114. Each ramp of first proximal ramps 114may include a third inclined contact surface 114 a extending away frombuttress block 257 and inclined with respect to an inside surface 112 ofendplate 110. Similarly, each ramp of first distal ramps 116 may includea fourth inclined contact surface 116 a extending away from buttressblock 257 and inclined with respect to an inside surface 112 of endplate110. In the exemplary embodiment, the third inclined contact surfacesextend a third length (third distance) and the fourth inclined contactsurfaces extend a fourth length (fourth distance) and the third lengthis greater than the fourth length.

Each ramp of ramps 114, 116, 124, 126 may have an inside surfacedisposed adjacent to and facing the rotation axis of moving mechanism250 and an outside surface opposite the inside surface and facing awayfrom the rotation axis of moving mechanism 250. Additionally, each rampof ramps 114, 116, 124, 126 may include a corresponding guide wall 130,which is best illustrated in FIGS. 12A and 17 . Each guide wall 130 mayextend along the inside surface of a corresponding ramp in a paralleldirection to the corresponding contact surface. For example, withreference to FIGS. 12A-13B, guide wall 130 extends along the insidesurface of proximal ramp 124 in a direction that is substantiallyparallel to first inclined contact surface 124 a. As best understoodwith reference to FIGS. 12A-12B, each bottom most projection 256 c ofthe first trolley 256 is disposed inside of a corresponding guide wall130 of the second proximal ramps 124. Likewise, each bottom mostprojection 258 c of the second trolley 258 is disposed inside of acorresponding guide wall 130 of the second distal ramps 126. Similarly,although not directly visible, in FIGS. 13A-13B each top most projection256 c of the first trolley 256 is disposed inside of a correspondingguide wall 130 of first proximal ramps 114. Likewise, each top mostprojection 258 c of second trolley 258 is disposed inside of acorresponding guide wall 130 of first distal ramps 116.

With reference to FIGS. 13A and 13B, when first surgical tool 400 is inthe first position and translates first and second screws 252, 254 inthe first direction the first and second trolleys 256, 258 move awayfrom one another in opposite directions and the top endplate 110 andbottom endplate 120 move away from one another as the spinal implant 100expands. For example, in some embodiments, beveled edges 256 a, 256 b ofthe first trolley 256 act against endplates 110, 120 at a proximal end101 thereof and the first plurality of wedges 256 d contact and slidealong a corresponding ramp of the first and second first proximal ramps114, 124. However, in other embodiments, 256 e and 256 f may act againstinclined contact surface 124 a in lieu of providing beveled edges 256 a,256 b. In some embodiments, beveled edges 258 a, 258 b of the secondtrolley 258 act against endplates 110, 120 at a distal end 102 thereofand the second plurality of wedges 258 d contact and slide along acorresponding ramp of the first and second first distal ramps 116, 126.However, in other embodiments, 258 e and 258 f may push against inclinedcontact surface 126 a in lieu of providing beveled edges 256 a, 256 b.Additionally, each projection 256 c of the first trolley 256 slidesalong a corresponding guide wall 130 of the first and second firstproximal ramps 114, 124 and each projection 258 c of the second trolley258 slides along a corresponding guide wall 130 of the first and seconddistal ramps 116, 126. Furthermore, during the expansion of spinalimplant 100 each projection 257 c of buttress block 257 may slidevertically in a corresponding vertical guide wall 130 a (see FIG. 17 )of the top and bottom endplates 110, 120. In this way, the spinalimplant 100 moves from a contracted position to an expanded position. Itshall be understood that movement of spinal implant from the expandedposition to the contracted position occurs in substantially the sameway.

When first surgical tool 400 is in the second position and translatesonly the first screw 252 in the first direction the first trolley 256moves away from buttress block 257 and stationary second trolley 258 andan angle of inclination between the top endplate 110 and bottom endplate120 increases. For example, beveled edges 256 c of first trolley 256 maypush against endplates 110, 120 at a proximal end 101 thereof and/or thefirst plurality of wedges 256 d may contact and slide along acorresponding ramp of the first and second first proximal ramps 114, 124as explained above. Additionally, each projection 256 c of the firsttrolley 256 slides along a corresponding guide wall 130 of the first andsecond first proximal ramps 114, 124 as explained above. The secondtrolley 258 remains stationary with beveled edges 258 a, 258 b remainingin contact with endplates 110, 120 at a distal end 102 thereof and thesecond plurality of wedges 258 d remaining in contact with acorresponding ramp of the first and second distal ramps 116, 126. Due tofirst trolley 256 acting against endplates 110, 120 by moving away frombuttress block 127 and second trolley 258 remaining stationary thesecond plurality of wedges 258 d pivot along a corresponding ramp of thefirst and second distal ramps 116, 126 and each projection 258 c of thesecond trolley 258 pivots and/or incrementally slides along acorresponding guide wall 130 of the first and second first distal ramps116, 126. Furthermore, during the expansion of spinal implant 100 eachprojection 257 c of buttress block 257 may slide vertically up and downin a corresponding vertical guide wall 130 a (see FIG. 17 ) of the topand bottom endplates 110, 120 as necessary. In this way, a distancebetween endplates 110, 120 at the proximal end 101 is increased and adistance between endplates 110, 120 at the distal end 102 is minutelydecreased thereby adjusting an angle of inclination between top endplate110 and bottom endplate 120. Those with skill in the art, willappreciate that in disclosed exemplary embodiments first set screw 252is longer than second set screw 254 thereby providing more room fortravel of the first trolley 256 such that the first trolley 256 mayenable a greater distance of travel between endplates 110, 120 at theproximal end 101 than second trolley 258 enables at the distal end 102.

FIGS. 14A and 14B are cut-out views of a moving mechanism 250 inrelation to a top endplate 110. As shown, moving mechanism 250 includesa rotation axis R₁ projecting in a longitudinal direction thereof andextending in a transverse direction of endplate 110 (from proximal side101 to distal side 102). Rotation axis R₁ projects through the center ofset screws 252, 254. Moving mechanism 250 includes a transverse axis T₁intersecting a center of rotation axis and projecting perpendicular torotation axis R₁ through buttress block 257.

FIG. 15 illustrates a cross section of moving mechanism 250 taken alongrotation axis R₁. As shown, first set screw 252 is operably coupled withfirst trolley 256 by a plurality of keyed projections 256 k (threadpattern) that correspond to the pitch pattern of first set screw 252.Second set screw 254 is operably coupled with second trolley 258 by aplurality of keyed projections 258 k (thread pattern). First set screw252 includes a first internal circumferential surface 252 a and secondset screw 254 includes a second internal circumferential surface. Thebuttress block 257 includes an interior retention cavity 257 b where afirst retaining portion 252 r of first set screw 252 and a secondretaining portion 254 r of second set screw 254 are retained. Interiorretention cavity 257 b may be an internal cavity spanning the insidecircumference of buttress block 257 and configured to enable first setscrew 252 and second set screw 254 to freely rotate along the rotationaxis R₁ while preventing first set screw 252 and second set screw 254from traveling in the longitudinal direction of moving mechanism 250.

FIG. 16 is a perspective view of a top endplate 110 and bottom endplate120 of spinal implant 100 and FIG. 17 is an exploded view of the topendplate 110 and bottom endplate 120 of FIG. 16 . In the exemplaryembodiment, when spinal implant 100 is in the closed position, insidesurface 112 of top endplate 110 and inside surface 124 of bottomendplate 120 are nested or partially nested with respect to one another.For example, FIG. 16 shows first proximal ramps 114 of top endplate 110inset from second proximal ramps 124 of bottom endplate 120.Additionally, top endplate 110 includes a first plurality of recesses110 n that allow corresponding components of bottom endplate 120 a tonest inside of when spinal implant 100 is in the contracted position.For example, FIG. 16 shows second proximal ramps 124 nested inside ofrecess 110 n. In some embodiments, recesses 110 n may be referred to asnested recesses for convenience in explanation.

Top endplate 110 and/or bottom endplate 120 may optionally include atleast one anchoring aperture 129. In the exemplary embodiment, topendplate 110 includes a pair of top anchoring apertures 129 a, 129 b,that pass through top endplate 110 at an inclined angle with respect tooutside surface 111 of top endplate 110. Similarly, bottom endplate 120includes a pair of bottom anchoring apertures 129 c, 129 d that passthrough bottom endplate 120 at an inclined angle with respect to outsidesurface 121 of endplate 120. Each anchoring aperture 129 of theplurality of anchoring apertures 129 a-129 d is disposed adjacent anoutside surface of a corresponding ramp 114, 116 however exemplaryembodiments are not limited to the specific location shown in FIG. 17 .

FIGS. 18A-18B are perspective views of a first surgical tool 400 of anadjustable spinal implant system in accordance with the principles ofthe present disclosure. FIGS. 19A-19B are side views of the firstsurgical tool 400 and a corresponding adjustment rod 450 configured forinsertion inside of first surgical tool 400. Tip 406 is configured toconnect to spinal implant 100 such that spinal implant 100 is securelyattached to first surgical tool 400 by engaging locking mechanism 408.Similarly, tip 406 is configured to disconnect from spinal implant 100such that spinal implant 100 is no longer securely attached to firstsurgical tool 400 by disengaging locking mechanism 408. For example,FIG. 19A shows tip 406 in a first locking position with tip grips 406 abeing expanded for gripping onto spinal implant 100 and FIG. 19B showstip 406 in a second locking position with tip grips 406 a beingretracted. Locking mechanism 408 is configured to toggle between thefirst locking position and second locking position. In some embodiments,when locking mechanism 408 is engaged in the first locking positionspinal implant 100 is fixedly coupled to first surgical tool 400 suchthat it will not rotate. This may be advantageous for initialpositioning of spinal implant 100 between vertebral bodies duringsurgery. Additionally, first surgical tool 400 includes a positioningmechanism 410 configured to position adjustment rod 450 in a firstposition and a second position (see FIG. 19A). First surgical tool 400may also include a push button 420 to toggle between positioningadjustment rod 450 in a first position to engage both first and secondset screws 252, 254 and a second position to engage only the first setscrew 252 (see FIG. 18B). Furthermore, in some embodiments firstsurgical tool 400 may include a window 421 to identify whether bothfirst and second set screws 252 254 are engaged for parallelexpansion/contraction of spinal implant 100 or whether only the firstset screw 252 is engaged for adjusting an angle of inclination of spinalimplant 100.

In the exemplary embodiment, first surgical tool 400 includes a centralshaft aperture 409 extending through handle 402, shaft 404, and tip 406.Central shaft aperture 409 is configured to receive adjustment rod 450therein such that adjustment knob 452 is rotatable therein andprotrudes, at least partly, from both ends. Adjustment rod 450 includesan adjustment knob 452, first and second positioning surfaces 453, 454and keyed circumferential surface 456. When adjustment rod 450 ispositioned within central shaft aperture 409, adjustment knob 452protrudes from one end and keyed circumferential surface 456 protrudesfrom the other end (see FIG. 14 ). With adjustment rod 450 insertedwithin central shaft aperture 409 positioning mechanism 410 can extendand retract adjustment rod 450 in the longitudinal direction of shaft409. As explained above with respect to FIGS. 13A and 13B, when firstsurgical tool 400 is in the first position, keyed circumferentialsurface 456 may rotate first and second set screws 252, 254 along therotation axis and when first surgical tool 400 is in the secondposition, keyed circumferential surface 456 may rotate only the firstset screw 252 along the rotation axis. In some embodiments, positioningmechanism 410 is configured to be toggled between a first position and asecond position where it can act against positioning surfaces 453, 454to extend and retract adjustment rod 450 in the longitudinal directionof shaft 409. For example, in the first position positioning mechanism410 may extend adjustment rod 450 from tip 406 to an extended positionwhere circumferential surface 456 may engage with internalcircumferential surfaces of the first and second set screws 252, 254. Inthe second position, positioning mechanism 410 may retract adjustmentrod 450 through tip 406 to a partially retracted position wherecircumferential surface 456 may only engage with internalcircumferential surface of the first set screw 252. An internal gearingof positioning mechanism 410 may include internal locking pins andsurfaces that act against positioning surfaces 453, 454 such that whenan exposed turn dial knob of positioning mechanism 410 is turned to aparticular position, the internal locking pins and surfaces act againstthe inclined and recessed surfaces of positioning surfaces 453, 454.

Additionally, in some embodiments, first surgical tool 400 may beconfigured to receive adjustment rods 450 of varying lengths havingvarying outside circumferential surfaces 456 and positioning surfaces453, 454. For example, first surgical tool 400 may be configured toreceive a first relatively shorter adjustment rod 450 optimized for usefor a spinal implant 100 using corresponding relatively smallerendplates 110, 120 of FIGS. 6A-7C and a corresponding smaller movingmechanism 250 having a relatively shorter longitudinal axis optimizedfor such relatively shorter endplates 110 x, 120 x. For example still,first surgical tool 400 may be configured to receive a second relativelylonger adjustment rod 450 optimized for use for a spinal implant 100using corresponding relatively larger endplates 110 z, 120 z of FIGS.6A-7C and a corresponding larger moving mechanism 250 having arelatively longer longitudinal axis optimized for such relatively longerendplates 110 z, 120 z.

Additionally, in some embodiments, first surgical tool 400 may beconfigured to receive multiple types of adjustment rods 450. In at leastone embodiment, first surgical tool 400 may receive a first adjustmentrod 450 with an outside circumferential surface 456 that is configuredto engage (1) both the first and second set screws 252, 254 at the sametime and (2) the first set screw 252. For example, the first adjustmentrod 450 may be toggled between (1) a first position where outsidecircumferential surface 456 is fully extended and configured to engageboth the first and second set screws 252, 254, and (2) a second positionwhere outside circumferential surface 456 is partially extended (and/orpartially retracted) to engage only the first set screw 252. In analternate embodiment, first surgical tool 400 may receive a secondadjustment rod 450 with an outside circumferential surface 456 that isconfigured to engage only one set screw 252, 254 at a time. For example,the outside circumferential surface 456 may have an engagement surfacewith a longitudinal length that corresponds to a single set screw 252,254 such that it only engages with a single set screw 252, 254 at atime. For example, the second adjustment rod 450 may be toggled between(1) a first position where outside circumferential surface 456 is fullyextended and configured to engage the second set screw 254 independentlyof the first set screw 252 and (2) a second position where outsidecircumferential surface 456 is partially extended (and/or partiallyretracted) to engage only the first set screw 252. At least oneadvantage of having first surgical tool 400 being configured to receivemultiple types of adjustment rods 450 of varying lengths and havingoutside circumferential surfaces of different lengths is that a surgeoncan quickly and easily select the appropriate adjustment rod 450. Forexample, a surgeon may select first adjustment rod 450 toexpand/contract a spacing between endplates 110, 120 by the same orsubstantially the same amount while maintaining the angle of inclinationbetween endplates 110, 120, i.e., by engaging both first and second setscrews 252, 254. Additionally, a surgeon may select second adjustmentrod 450 to selectively increase/decrease an angle of inclination betweenendplates of spinal implant 100 at the proximate side 101 and the distalside 102 independently, i.e., by only engaging one of first and secondset screws 252, 254 at a time. For example still, the second adjustmentrod 450 may be configured to adjust spinal implant 100 to enableanterior expansion separately from enabling posterior expansion whichmay enable spinal implant 100 to be placed in kyphosis as is consistentwith above explained embodiments.

Furthermore, in some embodiments, first surgical tool 400 is configuredto operate in three modes. In the first mode, tip grips 406 a aresecurely connected to spinal implant 100. In the second mode, adjustmentrod 450 may be positioned in a first position such that upon selectiverotation of adjustment knob 452 a spacing between endplates 110, 120selectively increase/decrease in minute increments. For example, byrotating each of first set screw 252 and second set screw 254. In thethird mode, adjustment rod 450 may be positioned in a second positionsuch that upon selective rotation of adjustment knob 452 an angle ofinclination between endplates 110, 120 may selectively increase/decreasein minute increments. For example, by only rotating first set screw 252an angle of inclination between endplates 110, 120 may increase/decreaseby moving one side of the endplates 110,120 towards/away from each otherand moving the opposite side of the endplates 110,120 in an oppositedirection. In some embodiments, this may also happen by only rotatingsecond set screw 254. For example, first surgical tool 400 may have arelatively short circumferential engagement surface 456 that will onlyengage a single one of the internal circumferential surfaces of first orsecond set 252, 254 at a time.

FIG. 20 illustrates a perspective view of one embodiment of anexpandable spinal implant 100 including a plurality of anchoring screws510. In some embodiments, anchoring screws 510 may be referred to asbone screws. In the exemplary spinal implant 100, top endplate 110includes a first anchoring screw 510 a, and a second anchoring screw 510b opposite the first anchoring screw 510 a that each extend through acorresponding aperture. For example, first and second anchoring screws510 a, 510 b pass through a corresponding aperture of top endplate 110configured to orient them at an inclined angle with respect to outsidesurface 111 of top endplate 110. Similarly, bottom endplate 120 includesa third anchoring screw 510 c, and a fourth anchoring screw 510 d thateach extend through a corresponding aperture. Anchoring screws 510 c,510 d project from a proximal end 101 of spinal implant 100 at aninclined angle towards distal end 102. For example, third and fourthanchoring screws 510 c, 510 d pass through a corresponding aperture ofbottom endplate 120 configured to orient them at an inclined angle withrespect to outside surface 121 of bottom endplate 120. However, it shallbe understood that in other embodiments at least one aperture may orienta corresponding anchoring screw 510 a, 510 b, 510 c, 510 d at any anglewith respect to the corresponding endplate 110, 120 consistent with thedisclosure herein. Anchoring screws 510 a-510 d are configured to anchorinto corresponding adjacent vertebral bodies.

FIGS. 21A-21B illustrate a lateral side view and front side view,respectively, of one embodiment of an expandable spinal implant systemin which anchoring screws 510 a-510 d are anchored into adjacentvertebral bodies. As illustrated, anchoring screws 510 a, 510 b projectout from top endplate 110 of spinal implant 100 from a proximal end 101at an inclined angle towards distal end 102 thereby anchoring into a topvertebral body V₁. Similarly, anchoring screws 510 a, 510 b project outfrom bottom endplate 120 of spinal implant 100 from a proximal end 101at an inclined angle towards distal end 102 thereby anchoring into abottom vertebral body V₂. As used herein, a pair of vertebral bodies,adjacent vertebral bodies, and/or first and second vertebral bodies mayrefer to, e.g., top vertebral body V₁ and bottom vertebral body V₂.

FIG. 22A is a side view of a second surgical tool 500 suitable for usewith disclosed embodiments and systems herein, e.g., to drive anchoringscrews 510 a-510 d. FIG. 22B is a side view of an enlarged region ofFIG. 22A. Exemplary, second surgical tool 500 includes a ratchetingdrive shaft 555, a positioning handle 520, a tip portion 530, a driveshaft housing 540, and a trigger 550. Ratcheting drive shaft 555 may beconfigured to connect and disconnect with a ratcheting handle (notshown) and rotate within ratcheting drive shaft housing 540. Forexample, the drivable connection may comprise a variety of driveinterfaces including but not limited to: multi-lobular drives;hexalobular drives; cross or Phillips head drives; straight or “flathead” drives; square or other polygonal drives; and/or combinationsthereof. Positioning handle 520 may be configured to assist withmaintaining and controlling the second surgical tool 500, e.g., in viewof torque transmitted through ratcheting drive shaft 555. Tip portion530 is angled at a degree β with respect to a longitudinal direction ofdrive shaft housing 540. In some embodiments, tip portion 530 is angledsuch that the degree β corresponds to the inclination of anchoringscrews 510 a-510 d and the inclination of anchoring aperture 129. Forexample, anchoring apertures 129 may be inclined about 30°-50°, and moreparticularly about 40°, with respect to an outside surface 111, 121 ofendplates 110, 120. This arrangement may be advantageous for drivinganchoring screws 510 a-510 d while spinal implant 100 is positionedbetween adjacent vertebral bodies. Tip portion 530 may secure anchoringscrew 510 in an internal cavity therein such that anchoring screw 510may not disconnect during initial positioning of anchoring screw 510.For example, tip portion 530 may have a flexible elastic memberconfigured to securely retain a head portion of anchoring screw 510. Tipportion 530 may, however, release anchoring screw 510 when anchoringscrew is sufficiently anchored into an anatomical feature, such as avertebrae for example. This feature may be particularly advantageousduring surgery for maintaining the anchoring screw 510 in tip portion530 such that anchoring screw 510 does not uncouple from tip portion 530when initially positioning anchoring screw 510 in an anchoring aperture,for example anchoring aperture 129. Additionally, in some embodimentstip portion 530 is operably coupled with trigger 550 such that trigger550 may disconnect anchoring screw 510 when anchoring screw 510 isinstalled. In some embodiments, trigger 550 may not be necessary becausetip portion 530 may self-release anchoring screw 510 after installation.

FIGS. 23A-23C are various perspective views of exemplary anchoringscrews suitable for use with disclosed embodiments herein in conjunctionwith the second surgical tool 500. FIG. 23A shows a trocar tip anchoringscrew 510 e, FIG. 23B shows a flutes or fluted tip anchoring screw 510f, and FIG. 23C shows a speed anchoring screw 510 g. Each anchoringscrew 510 e-510 g may have a thread pitch and sizing that corresponds toa size of anchoring aperture 129. Trocar tip anchoring screw 510 eincludes an angled tip portion 510 e-1 and a thread pattern includingthreads 510 e-2. Threads 510 e-2 may be spaced back from angled tipportion 510 e-1 which may facilitate with aligning anchoring screw 510 ewith anchoring aperture 129. For example, in some embodiments, threads510 e-2 are spaced back about 3 mm from angled tip portion 510 e-1.Fluted tip anchoring screw 510 f includes a cutting tip 510 f-1 and athread pattern included threads 510 f-2. Cutting tip 510 f-1 may extenda relatively long distance from the beginning of threads 510 f-2 suchthat the cutting tip 510 f-1 may pre-drill into an adjacent vertebralbody before the threads 510 f-2 engage with anchoring aperture 129. Forexample, in some embodiments, threads 510 f-2 are spaced back about 8 mmfrom cutting tip 510 f-1. Speed anchoring screw 510 g includes a conicaltip 510 g-1 and a thread pattern including threads 510 g-2. Differentfrom trocar tip anchoring screw 510 e and fluted tip anchoring screw 510f, threads 510 g-2 of speed anchoring screw 510 g may begin immediatelyadjacent conical tip 510 g-1.

FIGS. 24A-24D are various side views and top down views of exemplarybone graft areas in accordance with the principles of the presentdisclosure. In the side view of FIG. 24A, first and second regions R₁,and R₂ are shown where bone growth material may be grafted and/or bonegrowth promoting materials may be used. In the top down view of FIG.24B, third and fourth regions R₃, R₄ are shown where bone growthmaterial may be grafted and/or bone growth promoting materials may beused. In some embodiments, third and fourth regions R₃, R₄ overlapvertically with first and second regions R₁, and R₂. In FIGS. 24C and24D an exemplary grafting section GS is shown. Grafting section GS maybe grafted to an endplate 110, 120. In some embodiments, graftingsection GS may be filled with a bone growth material having a resultantsurface area ranging from about 140 mm² to about 180 mm, and moreparticularly about 160 mm². For example, the bone growth material mayextend through the grafting section GS three dimensionally and have acorresponding surface area ranging from about 140 mm² to about 180 mm²,and more particularly about 160 mm². Consistent with disclosedembodiments herein, the open arrangement of spinal implant 100 andendplates 110, 120 in particular is advantageous for direct segmentalfusion techniques. For example, the superior and inferior vertebralendplates allow the creation of a fusion bone bridge to solidify asegment. Additionally, the expandable and contractible nature of spinalimplant 100 lends to bone packing techniques after positioning andadjusting spinal implant 100 between vertebral bodies. For example,after spinal implant 100 is positioned between adjacent vertebralbodies, spinal implant 100 may be packed with bone material in situ. Insome embodiments, the endplate 110 may be considered a direct superiorvertebral endplate and endplate 120 may be considered an inferiorvertebral endplate where such endplates are configured to allow for afusion bone bridge there through to solidify a segment.

In some embodiments, the spinal implant system includes an agent,including but not limited to the bone growth promoting materialsdescribed herein, which may be disposed, packed, coated or layeredwithin, on or about the components and/or surfaces of the spinal implantsystem. In some embodiments the bone growth promoting material may bepre-packed in the interior of spinal implant 100, and/or may be packedduring or after implantation of the implant via a tube, cannula, syringeor a combination of these or other access instruments. Additionally,bone growth promoting material may be further tamped into spinal implant100 before, during or after implantation. In some embodiments, the bonegrowth promoting material and/or directly grafted material may enhancefixation of spinal implant 100 with adjacent bony structures. In someembodiments, the agent may include one or a plurality of therapeuticagents and/or pharmacological agents for release, including sustainedrelease, to treat, for example, pain, inflammation and degeneration.

FIGS. 25A and 25B illustrate spin implant 100 in a first bent positionand a second bent position, respectively. FIG. 25A shows spinal implant100 where top endplate 110 is bent in a first lateral direction withrespect to bottom endplate 120. FIG. 25B shows spinal implant 100 wheretop endplate 110 is bent in a second lateral direction, opposite thefirst lateral direction, with respect to bottom endplate 120. Asexplained in greater detail above, the various disclosed projections,guide walls, cavities, recesses, etc. are configured such that spinalimplant 100 may allow for lateral bending to some predetermined degree.For example, projections 256 c, 257 c, 258 c may pivot laterally inguide walls 130 to accommodate some degree of lateral bending. In thisway, top endplate 110 and bottom endplate 120 may be configured tolaterally bend with respect one another in a first direction and asecond direction by a predetermined amount. However, in otherembodiments it may be desirable for spinal implant 100 to be rigid inthe lateral direction and for no lateral bending to be permissible.

FIGS. 26-28 illustrate a left side view, right side view, and front sideview, respectively, of an installed expandable spinal implant 100positioned between adjacent vertebral bodies according to varioussurgical techniques, e.g., anterior techniques, oblique techniques,lateral techniques. For example, FIGS. 26-28 show spinal implant 100after being installed according to an anterior lumbar interbody fusion(ALIF) technique.

Spinal implant systems of the present disclosure can be employed with asurgical arthrodesis procedure, such as, for example, an interbodyfusion for treatment of an applicable condition or injury of an affectedsection of a spinal column and adjacent areas within a body, such as,for example, intervertebral disc space between adjacent vertebrae, andwith additional surgical procedures and methods. In some embodiments,spinal implant systems can include an intervertebral implant that can beinserted between adjacent vertebral bodies to space apart articularjoint surfaces, provide support for and maximize stabilization ofvertebrae. In some embodiments, spinal implant systems may be employedwith one or a plurality of vertebra.

Consistent with the disclosed embodiments herein, a medical practitionermay obtain access to a surgical site including vertebrae such as throughincision and retraction of tissues. Spinal implant systems of thepresent disclosure can be used in any existing surgical method ortechnique including open surgery, mini-open surgery, minimally invasivesurgery and percutaneous surgical implantation, whereby vertebrae areaccessed through a mini-incision, retractor, tube or sleeve thatprovides a protected passageway to the area, including, for example, anexpandable retractor wherein the sleeve is formed from multiple portionsthat may be moved apart or together and may be inserted with theportions closed or together and then expanded to allow for insertion ofimplants of larger size than the closed cross section of the unexpandedretractor portions. In one embodiment, the components of the spinalimplant system are delivered through a surgical pathway to the surgicalsite along a surgical approach into intervertebral disc space betweenvertebrae. Various surgical approaches and pathways may be used.

As will be appreciated by one of skill in the art, a preparationinstrument (not shown) may be employed to remove disc tissue, fluids,adjacent tissues and/or bone, and scrape and/or remove tissue fromendplate surfaces of a first vertebra and/or endplate surface of asecond vertebra in preparation for or as part of the proceduresutilizing a system of the present disclosure. In some embodiments, thefootprint of spinal implant 100 is selected after trialing usingtrialing instruments (not shown) that may approximate the size andconfiguration of spinal implant 100. In some embodiments, such trialsmay be fixed in size and/or be fitted with moving mechanisms 250 similarto embodiments described herein. In some embodiments, spinal implant 100may be visualized by fluoroscopy and oriented before introduction intointervertebral disc space. Furthermore, first and second surgical tools400, 500, and spinal implant 100 may be fitted with fiducial markers toenable image guided surgical navigation to be used prior to and/orduring a procedure.

Components of a spinal implant systems of the present disclosure can bedelivered or implanted as a pre-assembled device or can be assembled insitu. In one embodiment, spinal implant 100 is made of a single piececonstruction that may not be disassembled without destroying the device.In other embodiments, spinal implant 100 may comprise removable parts.Components of spinal implant system including implant 10, 20, 30 may beexpanded, contracted, completely or partially revised, removed orreplaced in situ. In some embodiments, spinal implant 100 can bedelivered to the surgical site via mechanical manipulation and/or a freehand technique.

Additionally, components of spinal implant 100 can include radiolucentmaterials, e.g., polymers. Radiopaque markers may be included foridentification under x-ray, fluoroscopy, CT or other imaging techniques.Furthermore, first and second surgical tools 400, 500 may be radiolucentand may optionally include markers added at a tip portion thereof topermit them to be seen on fluoroscopy/x-ray while advancing into thepatient. At least one advantage to having spinal implant 100 is that amedical practitioner can verify the positioning of spinal implant 100relative to adjacent vertebral bodies and make further adjustments tothe spacing between endplates 110, 120, angle of inclination betweenendplates 110, 120, and the overall positioning of the device within apatient's body. In this way, spinal implant 100 may correct alignment ofa patient's spine in a sagittal plane.

FIG. 29A is a perspective view of a second embodiment of an expandablespinal implant 200 in accordance with the principles of the presentdisclosure. Aspects of second spinal implant 100 may be the same as,substantially the same as, or similar to spinal implant 100.Additionally, second spinal implant 200 may be used in previouslydisclosed systems and methods. Accordingly, duplicative descriptionthereof will be omitted.

FIG. 29B is an exploded view illustrating second spinal implant 200.Second spinal implant 200 a top endplate 110 (first endplate) and abottom endplate 120 (second endplate) and a moving mechanism 2500, whichwill be described in greater detail below. The proximal end 101 includesa screw guide endplate 1050 disposed between endplates 110 and 120. Insome embodiments, screw guide endplate 1050 may be pivotable left-rightand up-down to accommodate insertion of first surgical tool 400 from anoff angle position. For example, screw guide endplate 1050 mayaccommodate a surgical tool that is insert off angle (not axiallyaligned) in a range of about 1° to 20°, and more particularly about 1°to 15° in the horizontal and vertical directions. At least one advantageof this arrangement is that first surgical tool 400 may be inserted offangle with respect to guide aperture 107 of spinal implant 200.

In the exemplary embodiment, moving mechanism 2500 is operably coupledto top endplate 110 and bottom endplate 120 similarly as explainedabove. Moving mechanism 2500 differs from moving mechanism 250 in thatmoving mechanism 2500 may be miss aligned, for example by about 5°, 10°,15°, or 20° when compared to moving mechanism 250 of the firstembodiment. In at least one embodiment, moving mechanism 2500 ismisaligned about 15° to facilitate insertion and posterior adjustment byreconnection posteriorly. In the exemplary embodiment, moving mechanism2500 operates by the same principles as moving mechanism 250 althoughthe interior contours of top endplate 110 and bottom endplate 120 areshifted to allow moving mechanism 2500 to be miss aligned.

FIG. 30A is a top down view of spinal implant 200 contrasting anembodiment where moving mechanism 2500 is miss aligned. As illustrated,spinal implant 200 has a first reference axis B₁ and a second referenceaxis B₂. First reference axis B₁ may be understood as a projection wheremoving mechanism 2500 is not miss aligned and where moving mechanism2500 is in a centered position. Second reference axis B₂ may beunderstood as a projection passing through a central portion of guideaperture 107 through moving mechanism 2500 when moving mechanism 2500 ismiss aligned inside of endplates 110, 120 to an off-centered position.

Referring generally to FIGS. 30B-30F, a modified embodiment of spinalimplant 200 where moving mechanism 2500 is miss aligned is disclosed. Inthe disclosed embodiment, moving mechanism 2500 features the same partsas moving mechanism 250 and operates under the same principles asexplained previously. In the disclosed embodiment, moving mechanism 2500is miss aligned by about 15° when compared with moving mechanism 250 ofspinal implant 100. In other embodiments, moving mechanism 2500 may bemiss aligned within any suitable range, e.g., from about 5° to 25°. FIG.30C is a perspective view of the embodiment of FIG. 30B with a topendplate 110 removed for ease of understanding. As illustrated, movingmechanism 2500 is misaligned and the top and bottom endplates 110, 120have a different geometry to accommodate the miss aligned movingmechanism 2500. Top and bottom endplates 110, 120 may feature the sameor substantially the same characteristics as previously disclosed. FIG.30D is an alternate perspective view of the embodiment of FIG. 30B witha top endplate 110 removed for ease of understanding. FIG. 30E is a topdown view of an exemplary top endplate 110 for use with the embodimentof FIG. 30B and FIG. 30F is a top down view of an exemplary bottomendplate 120 for use with the embodiment of FIG. 30B.

FIG. 31 is a perspective view of spinal implant 200 in an installedposition between vertebral bodies and three alternate positions of firstsurgical tool 400. FIG. 31 shows how first surgical tool 400 may beinserted into guide aperture 107 off angle with respect to firstreference axis B₁. Reference ring RR represents the extent of viableoffset positions that first surgical tool 400 may be operably insertedin guide aperture 107. In some embodiments, first surgical tool 400 maybe bent at a midsection area at 15° to enable a surgeon to adjust spinalimplant 200 in such a way as to avoid anatomical features and organs,such as, for example the pelvic ring and iliac crest. Additionally, thisadvantage is further expanded upon when using a miss-aligned movingmechanism 2500 that is miss aligned by, for example, about 15°.Therefore, disclosed systems of spinal implant 200 are able to bemanipulated by a surgeon via surgical tool 400 at the combined totalangular extent the moving mechanism 2500 is offset and the angularextent the surgical tool is bent. In at least one embodiment, the totalangular extent is about 30° on account of the moving mechanism 2500being offset about 15° and the surgical tool 400 being bent about 15°.

FIG. 32A is a top down view of a third embodiment of an expandablespinal implant 300 in accordance with the principles of the presentdisclosure. FIG. 32B shows spinal implant 300 in a perspective view.Aspects of spinal implant 300 may be the same as, substantially the sameas, or similar to spinal implant 100. Additionally, spinal implant 300may be used in previously disclosed systems and methods. Accordingly,duplicative description thereof will be omitted.

In some embodiments, the sizing and orientation of top and bottomendplates 110, 120 and the sizing and orientation of moving mechanism250 d is particularly advantageous for lateral insertion techniques.Spinal implant 300 includes a first reference axis C₁ and a secondreference axis C₂. Different than previous embodiments, first referenceaxis C₁ may span a longitudinal length of spinal implant 300 and passdirectly through a rotation axis of moving mechanism 250 d. Secondreference axis C₂ may bisect spinal implant 300 transversely across thecenter thereof. Additionally, second reference axis C₂ may intersectfirst reference axis C₁ and project through a center of buttress block257.

Spinal implant 300 may include a top endplate 110 d and a bottomendplate 120 d and a moving mechanism 250, which may be the same as orsubstantially the same as described above. Spinal implant 300 includes aproximal end 101 and a distal end 102 opposite the proximal end 101, anda first lateral end 103 and a second lateral end 104 opposite the firstlateral end 103. The first and second lateral ends 103, 104 extendbetween the proximal end 101 and the distal end 102. The proximal end101 includes an exposed screw guide endplate 105 defining acorresponding screw guide aperture 107, which are disposed betweenendplates 110 d and 120 d. The screw guide endplate 105 and guideaperture 107 may be the same as or substantially the same as describedabove.

Top endplate 110 may include a first outside surface 111 d and a firstinside surface 112 d opposite the first outside surface 111 d.Similarly, bottom endplate 120 d may include a second outside surface121 d and a second inside surface 122 d. The outside surfaces 111 d, 121d may be configured to be positioned between and/or contact vertebralbodies in a patients spine and have various surface characteristicssimilar to those described above with reference to spinal implant 100.In some embodiments, outside surfaces 111 d and 122 d may have asubstantially linear surface profile across faces of textured surfacesthereof. In other embodiments, outside surfaces 111 d and 122 d may havecurved surface profiles across faces of textured surfaces thereof.Further details of endplates 110 d, 120 d will be described in greaterdetail below.

Inside surfaces 111 d, 122 d, may surround moving mechanism 250 and havevarious contours, guides, cavities, and other operable characteristicsthat facilitate movement and/or provide mechanical advantage to otheroperable and movable corresponding parts to facilitate contraction,angular adjustment, lateral bending, absorption of compression forces,shear forces, etc. as will be explained in greater detail below.

In the exemplary embodiment, top endplate 110 d includes a pair of firstproximal ramps 114 d and a pair of first distal ramps 116 d opposite thefirst proximal ramps 114 d. Each ramp of the first proximal ramps 114 dincludes an inclined surface extending away from inside surface 112 dand moving mechanism 250 d. Similarly, each ramp of first distal ramps116 d includes an inclined surface extending away from inside surface112 d and moving mechanism 250 d. Bottom endplate 120 d includes a pairof second proximal ramps 124 d and a pair of second distal ramps 126 dopposite the second proximal ramps 124 d. Each ramp of the secondproximal ramps 124 d includes an inclined surface extending away frominside surface 122 d and moving mechanism 250 d. Similarly, each ramp ofsecond distal ramps 126 d includes an inclined surface extending awayfrom inside surface 11 d 1 and moving mechanism 250 d.

Exemplary spinal implant 300 includes a moving mechanism 250 d that isoperably coupled to top endplate 110 d and bottom endplate 120 d,similarly as explained above with reference to spinal implant 100.Accordingly, duplicative description will not be repeated. A firstfunctional feature of moving mechanism 250 d is that it is furtherconfigured to increase and decrease a spacing between the top and bottomendplates 110 d, 120 d upon simultaneous rotation of first and secondset screws 252, 254 in a clockwise and counterclockwise direction,respectively. A second functional feature of moving mechanism 250 d isthat it is further configured to increase and decrease an angle ofinclination between top and bottom endplates 110 d, 120 d upon rotationof the first set screw 252 in a clockwise and counterclockwisedirection, respectively.

FIG. 33A is a perspective view of spinal implant 300 in a contractedposition and FIG. 33B is a perspective view of spinal implant 300 in anexpanded position. In the contracted position of FIG. 33A, top endplate110 d and bottom endplate 120 d are contracted to a fully closedposition. In the expanded position of FIG. 33B, top endplate 110 d andbottom endplate 120 d are expanded an equal amount. Similarly asexplained above with reference to spinal implant 100 and FIGS. 9A-9Bwhen first surgical tool 400 is inserted in guide aperture 107 in afirst position and rotated in a first direction (clockwise direction)the first and second trolleys 256, 258 move away from one another anequal amount in opposite directions. In turn, the first and secondtrolleys 256, 258 cause the top and bottom endplates 110 d, 120 d tomove apart from one another an equal amount. Likewise, when firstsurgical tool 400 is rotated in a second direction (counter-clockwisedirection) first and second trolleys 256, 258 cause the top and bottomendplates 110 d, 120 d to move towards one another an equal amount in acontraction direction (not illustrated). In summary, when positioningthe first surgical tool 400 in the first position and rotating the firstsurgical tool 400 in either the first or second direction the movingmechanism 250 d operably adjusts a spacing between the top and bottomendplates 110 d, 120 d. FIG. 33C is a perspective view of spinal implant300 in a first angled position and FIG. 33D is a perspective view ofspinal implant 300 in a second angled position. Spinal implant 300 mayhave the same or similar features as explained above with respect tospinal implants 100, 200. Spinal implant 300 may be capable of (1)expanding/contracting the proximal end while the distal end remainsstationary, (2) expanding/contracting the distal end while the proximalend remains stationary, and (3) expanding/contracting both the proximalend and distal end simultaneously. Similarly as explained above withreference to spinal implant 100 and FIGS. 10A-10B when first surgicaltool 400 is inserted in guide aperture 107 in a second position, androtated in a first direction (clockwise direction) the first trolley 256moves away from the proximal end 101 of spinal implant 100 and thesecond trolley 258 remains stationary in place. In effect, the top andbottom endplates 110 d, 120 d move towards one another at the distal end102 (not shown) and move away from one another at the proximal end 101thereby decreasing an angle of inclination between the top and bottomendplates 110, 120.

Likewise, when first surgical tool 400 is in the second position and isrotated in the second direction (counter-clockwise direction) the firsttrolley 256 moves towards the stationary second trolley 258. In effect,the top and bottom endplates 110 d, 120 d move towards one another atthe proximal end 101 (not shown) thereby decreasing an angle ofinclination between the top and bottom endplates 110 d, 120 d. Insummary, when positioning the first surgical tool 400 in the secondposition and rotating the first surgical tool 400 in either the first orsecond direction the moving mechanism 250 operably adjusts an angle ofinclination between the top and bottom endplates 110, 120 upon rotatingthe first set screw along the rotation axis.

In the contracted position of FIG. 33A, a first height between topendplate 110 d and bottom endplate 120 d on the proximal side 101 anddistal side 102 is about 9 mm. In the first expanded position of FIG.33B, a second height of spinal implant 300 between top endplate 110 dand bottom endplate 120 d on the proximal side 101 and distal side 102is about 9 mm. Additionally, in the first expanded position of FIG. 33B,top endplate 110 d is parallel with respect to bottom endplate 110 d. Inthe first angled position of FIG. 33C, the top and bottom endplates 110d, 120 d are contacting each other at the distal side 102 and are spacedapart from one another at the proximal side 101. For example, at thedistal side 102, the height between top endplate 110 d and bottomendplate 120 d is about 9 mm. For example still, at the proximate side101, the height between top endplate 110 d and bottom endplate 120 d isabout 16 mm. Accordingly, an angle of inclination between top endplate110 d and bottom endplate 120 d at the distal side 101 is about 11°. Inthe second angled position of FIG. 33D, the top and bottom endplates 110d, 120 d are contacting each other at the proximal side 102 and arespaced apart from one another at the distal side 101. For example, atthe proximal side 102, the height between top endplate 110 d and bottomendplate 120 d is about 9 mm. For example still, at the distal side 101,the height between top endplate 110 d and bottom endplate 120 d is about16 mm. Accordingly, an angle of inclination between top endplate 110 dand bottom endplate 120 d at the proximal side 101 is about 11°.

In some embodiments, spinal implant 300 may comprise a three positioninner drive shaft (not illustrated) complimentary to or in place ofcomponents of moving mechanism 250. The three position inner drive shaftmay enable the first and second set screws 252, 254 to be adjustedindependently from one another as well as enabling the first and secondset screws 252, 254 to be adjusted concurrently or simultaneously. Forexample, first surgical tool 400 may have a relatively shortcircumferential surface 456 that will only engage one of the internalcircumferential surfaces of first or second set screws 252, 254 at atime. For example still, another first surgical tool 400 having arelatively longer circumferential surface 456 may engage both of theinternal circumferential surfaces of the first and second set screws252, 254 at the same time. Consistent with disclosed embodiments, asurgeon can use a first surgical tool 400 having a relatively shortercircumferential surface 456 to perform angular adjustments of spinalimplant 300 and then use a first surgical tool 400 having a relativelylonger circumferential surface 456 to perform height adjustments ofspinal implant 300. In other embodiments, spinal implant 300 may includea screw guide aperture 107 on both sides of the spinal implant 300thereby providing access to the first set screw 252 independently fromsecond set screw 254.

FIG. 34 is a perspective view of a spinal implant system utilizingspinal implant 300 and first surgical tool 400. In the exemplary system,spinal implant 300 is positioned in an installed position betweenvertebral bodies by first surgical tool 400 according to lateralinsertion techniques as explained in greater detail above. Firstsurgical tool 400 may operably adjust spinal implant 300 in situ betweenvertebral bodies as explained in greater above. For example, firstsurgical tool 400 may operably expand spinal implant 300 at a proximalside 101 and/or a distal side 102 thereof. In this way, spinal implant300 may correct alignment of a patient's spine in a coronal plane.

FIG. 35 is a perspective view of a spinal implant system utilizingspinal implant 300 highlighting how first surgical tool 400 maymanipulate spinal implant 300 from various angles. For example, spinalimplant 300 may include the same, substantially the same, or similarcomponents to moving mechanism 2500 as explained above. In the exemplaryembodiment, first surgical tool 400 may be inserted into guide aperture107 off angle with respect to first reference axis B1. Reference ring RRrepresents the extent of viable offset positions that first surgicaltool 400 may be operably inserted in guide aperture 107. In someembodiments, first surgical tool 400 may be bent at a midsection area at15° (not illustrated) to enable a surgeon to adjust spinal implant 300in such a way as to avoid anatomical features and organs, such as, forexample the pelvic ring and iliac crest.

Referring generally to FIGS. 36-39B an additional expandable spinalimplant 600 is disclosed. Expandable spinal implant 600 may have thesame, substantially the same, and/or similar components and attributesas spinal implants 100, 200, and 300 including general applicabilitywith other relevant systems and surgical tools disclosed hereinabove.Spinal implant 600 may include a screw guide endplate 6150 having atleast one aperture 610 configured to receive an anchoring screw 510therein. Screw guide endplate 6150 may be relatively longer in lengththan screw guide endplate 150 discussed above and screw guide endplate6150 may be operably coupled with moving mechanism 250 similarly asexplained above with respect to spinal implants 100, 200, and 300.

In the illustrated embodiment, top endplate 110 and bottom endplate 120may each have an accommodating portion 630 having a corresponding sizeand geometry to the end portions of screw guide endplate 6150 such thatwhen spinal implant 600 is in the fully collapsed position the endportions of screw guide endplate 6150 will not increase a relativeheight of implant 600 in a fully collapsed position. For example,endplates 110, 120 may fully close without being impacted by screw guideendplate 6150 and therefore maintain a relatively compact size.

FIGS. 38A and 38B illustrate a front perspective view and a rearperspective view of an exemplary screw guide endplate 6150 having atleast one aperture 610 configured to receive an anchoring screw 510therein. In the illustrated embodiment, two apertures 610 are shownalthough embodiments in accordance with the principles of thisdisclosure may have any number of apertures 610. As illustrated, eachaperture 610 may be configured to selectively receive a correspondinganchoring screw therein. The outside entrance to each aperture 610 maydefine two alternate guided paths. For example, a first guided path maybe defined by the entrance to aperture 610 and a first exit aperture 610a and a second guided path may be defined by the entrance to aperture610 and a second exit aperture 610 b. In this way aperture 610 may beconfigured to orient one corresponding anchoring screw 510 at a time ineither of a first orientation or a second orientation.

Corresponding exemplary first and second orientations are illustrated inFIG. 37 which shows a first anchoring screw 510 (right anchoring screw)oriented upward at an inclined angle with respect to top endplate 110and a second anchoring screw 510 (left anchoring screw) orienteddownward at an inclined angle with respect to bottom endplate 120.Additionally, the first orientation may align a corresponding anchoringscrew 510 such that it projects through a corresponding slotted aperture640 of the first endplate 110 (see FIGS. 36 and 39A). Similarly, thesecond orientation may align a corresponding anchoring screw 510 suchthat it projects through a corresponding slotted aperture 640 of thesecond endplate 120 (see FIGS. 36 and 39B).

At least one advantage of the disclosed spinal implant 600 is that screwguide endplate 6150 and moving mechanism 250 may be configured such thatthe moving mechanism 250 can selectively adjust a spacing between thefirst and second endplates 110, 120 and adjust an angle of inclinationbetween the first and second endplates while the at least onecorresponding anchoring screw 510 is anchored within a correspondingvertebrae. For example, a surgeon may initially position spinal implant600 between adjacent vertebrae of a patient and install a correspondingfirst anchoring screw 510 in a first orientation projecting throughslotted aperture 640 of first endplate 110 and a corresponding secondanchoring screw 510 in a second orientation projecting through slottedaperture 640 of second endplate 120. Next, the surgeon may continue toadjust the spacing and/or angle of inclination between endplates 110,120 until the endplates 110, 120 are in the desired position. This ispossible, at least partly, because the relative location of the screwguide endplate 6150 remains fixed due to the anchored anchoring screws510 and the first and second endplates can freely expand/contract and/orincline/decline via moving mechanism 250 while anchoring screws 510extend through slotted aperture 640 (which has a geometry such that theanchored anchoring screws 510 do not interfere with the movement ofendplates 110, 120). For example, the endplates 110, 120 may freely movewhile anchoring screws 510 remain anchored in place in the correspondingvertebrae while also changing a relative positioning with respect to theslotted aperture 640 due to movement of endplates 110, 120.

Referring generally to FIGS. 40-44B an additional expandable spinalimplant 700 is disclosed. Expandable spinal implant 700 may have thesame, substantially the same, and/or similar components and attributesas spinal implants 100, 200, 300, and 600 including generalapplicability with other relevant systems and surgical tools disclosedhereinabove. Spinal implant 700 may include a screw guide endplate 7150having at least one aperture 710 configured to receive an anchoringscrew 510 therein. Screw guide endplate 7150 may be relatively longer inlength than screw guide endplate 150 discussed above and screw guideendplate 7150 may be operably coupled with moving mechanism 250similarly as explained above with respect to spinal implants 100, 200,and 300.

In the illustrated embodiment, top endplate 110 and bottom endplate 120may each have an accommodating portion 730 having a corresponding sizeand geometry to the end portions of screw guide endplate 7150 such thatwhen spinal implant 700 is in the fully collapsed position the endportions of screw guide endplate 7150 will not increase a relativeheight of implant 700 in a fully collapsed position. For example,endplates 110, 120 may fully close without being impacted by screw guideendplate 7150 and therefore maintain a relatively compact size.

FIGS. 42A and 42B illustrate an exemplary screw guide endplate 7150 withand without corresponding anchoring screws 510, respectively. FIGS. 43Aand 43B illustrate a front perspective view and a rear perspective viewof an exemplary screw guide endplate 7150 having at least one aperture710 configured to receive an anchoring screw 510 therein. In theillustrated embodiment, four apertures 710 are shown, althoughembodiments in accordance with the principles of this disclosure mayhave any number of apertures 710.

As illustrated, each aperture 710 may be configured to selectivelyreceive a corresponding anchoring screw 510 therein. The outsideentrance to each aperture 710 may define a guided path configured toorient a corresponding anchoring screw 510 in an inclined positionextending away from a proximal side of a corresponding endplate 110 or120. For example, screw guide endplate 7150 may include a total of fourapertures 710, and the four apertures 710 may include two top mostapertures 710 and two bottom most apertures 710. In the disclosedembodiment, the two top most apertures 710 may be configured to inclinea corresponding anchoring screw 510 with respect to top endplate 110that extends away from a proximal side of implant 700 towards a distalside of implant 700. Similarly, the two bottom most apertures 710 may beconfigured to incline a corresponding anchoring screw 510 with respectto bottom endplate 120 that extends from a proximal side of implant 700towards a distal side of implant 700. Corresponding orientations areillustrated in FIGS. 40, 41, and 42B which show two top anchoring screws510 oriented upward at an inclined angle with respect to top endplate110 and two bottom anchoring screws 510 oriented downward at an inclinedangle with respect to bottom endplate 120. Alternatively, the screwholes in the plate may be arranged and numbered in various alternativedesigns including, instead of two holes on top and bottom, presenting asingle hole in the center or on one side or the other on top and bottom,or two holes on one of the top or bottom and one hole on the oppositeside, top or bottom. These screw holes may further include protrusions,threads or other features to control, guide, and/or retain the screws inplace or include features such as retaining clips, springs, or covers toretain the screws in place once inserted. The screw holes may be ofvarious shapes including cylindrical, conical, or designed to receive abulbous or spherical screw head.

FIGS. 44A and 44B may illustrate a top endplate 110 and a bottomendplate 120, respectively, with an anchoring screw 510 in onecorresponding aperture 710 and without an anchoring screw 510 in theother corresponding aperture 710 for ease of explanation. Asillustrated, the top endplate 110 may include at least one anchoringscrew 510 such that it projects through or across a corresponding recess740 of the first endplate 110. Similarly, the bottom endplate 120 mayinclude at least one anchoring screw 510 such that it projects throughor across a corresponding recess 740 of the first endplate 110.

At least one advantage of the disclosed spinal implant 700 is that screwguide endplate 7150 and moving mechanism 250 may be configured such thatthe moving mechanism 250 can selectively adjust a spacing between thefirst and second endplates 110, 120 and adjust an angle of inclinationbetween the first and second endplates while the at least onecorresponding anchoring screw 510 is anchored within a correspondingvertebrae. For example, a surgeon may initially position spinal implant700 between adjacent vertebrae of a patient and install at least onecorresponding anchoring screw 510 in a first orientation projectingthrough or across a corresponding recess 740 of first endplate 110 andat least one corresponding anchoring screw 510 in a second orientationprojecting through or across recess 740 of second endplate 120. Next,the surgeon may continue to adjust the spacing and/or angle ofinclination between endplates 110, 120 until the endplates 110, 120 arein the desired position. This is possible, at least partly, because therelative location of the screw guide endplate 7150 remains fixed due tothe anchored anchoring screws 510 and the first and second endplates canfreely expand/contract and/or incline/decline via moving mechanism 250while anchoring screws 510 extend through or across recess 740 (whichhas a geometry such that anchored anchoring screws 510 do not interferewith the movement of endplates 110, 120). For example, the endplates110, 120 may freely move while anchoring screws 510 remain anchored inplace in the corresponding vertebrae.

FIG. 45 is a reference diagram illustrating various cardinal directionsand planes with respect to a patient that the exemplary embodiments ofFIGS. 1-44B may operate, adjust, and/or move along in accordance withthe principles of the present disclosure.

What is claimed is:
 1. An expandable spinal implant deployable between acontracted position and an expanded position, comprising: a firstendplate, the first endplate including: a first outside surface and afirst inside surface opposite the first outside surface, the firstinside surface including a first plurality of guide walls, a firstproximal end and a first distal end opposite the first proximal end,first proximal ramps and first distal ramps disposed opposite the firstproximal ramps, and a first lateral surface and a second lateral surfaceopposite the first lateral surface, the first and second lateralsurfaces extending between the first proximal end and the first distalend; a second endplate, the second endplate including: a second outsidesurface and a second inside surface opposite the second outside surface,the second inside surface including a second plurality of guide walls, asecond proximal end and a second distal end opposite the second proximalend, second proximal ramps and second distal ramps disposed opposite thesecond proximal ramps, and a third lateral surface and a fourth lateralsurface opposite the third lateral surface, the third and fourth lateralsurfaces extending between the second proximal end and the second distalend; a moving mechanism operably coupled to the first endplate and thesecond endplate and positioned therebetween, the moving mechanismincluding: a buttress block and a first trolley and a second trolleydisposed on opposite sides of the buttress block, a screw guide wallhousing a rotatable first set screw and a rotatable second set screwopposite the first set screw, the first set screw being operably coupledto the first trolley and the second set screw being operably coupled tothe second trolley, the first set screw and second set screw beingconfigured to rotate in a first rotation direction and a second rotationdirection about a rotation axis, the rotation axis projecting in alongitudinal direction of the moving mechanism, wherein the firsttrolley is operably coupled to the first set screw and movable towardand away the buttress block in the longitudinal direction of the movingmechanism by rotation of the first set screw along the rotation axis,the second trolley is operably coupled to the second set screw andmovable toward and away the buttress block in the longitudinal directionof the moving mechanism by rotation of the second set screw along therotation axis, wherein the first trolley includes a first side surfaceand a second side surface opposite the first side surface and has afirst plurality of projections projecting from the first and second sidesurfaces, the second trolley includes a third side surface and a fourthside surface opposite the third side surface and has a second pluralityof projections projecting from the third and fourth side surfaces,wherein the first and second plurality of projections correspond to across sectional shape of the first and second plurality of guide wallsand are operably coupled thereto, respectively, such that the first andsecond plurality of projections move along the first and secondplurality of guide walls, respectively, wherein the moving mechanism isconfigured to operably adjust a spacing between the first and secondendplates upon simultaneous rotation of the first and second set screwsalong the rotation axis, and wherein the moving mechanism is configuredto operably adjust an angle of inclination between the first and secondendplates upon rotating the first set screw or second set screw alongthe rotation axis.
 2. The spinal implant of claim 1, wherein the movingmechanism is further configured to: increase a first distance betweenthe first endplate and the moving mechanism and increase a seconddistance between the second endplate and the moving mechanism an equalamount upon simultaneous rotation of the first and second set screws inthe first rotation direction; decrease the first distance between thefirst endplate and the moving mechanism and decrease the second distancebetween the second endplate and the moving mechanism an equal amountupon simultaneous rotation of the first and second set screws in thesecond rotation direction; increase the angle of inclination between thefirst and second endplates upon rotating at least one of the first setscrew or second set screw along the rotation axis in the firstdirection; and decrease the angle of inclination of the first and secondendplates upon rotating at least one of the first set screw or secondset screw along the rotation axis in the second direction.
 3. The spinalimplant of claim 1, wherein the first proximal ramps include a first andsecond ramp disposed adjacent the first proximal end that project awayfrom the first inside surface, wherein the first distal ramps include athird and fourth ramp disposed adjacent the first distal end thatproject away from the first inside surface, wherein the second proximalramps include a fifth and sixth ramp disposed adjacent the secondproximal end that project away from the second inside surface, andwherein the second distal ramps include a seventh and eighth rampdisposed adjacent the second distal end that project away from thesecond inside surface.
 4. The spinal implant of claim 3, wherein thefirst trolley further comprises a first wedge projecting from the firstside surface in a transverse direction of the moving mechanism and asecond wedge projecting from the second side surface in the transversedirection of the moving mechanism, and wherein the second trolleyfurther comprises a third wedge projecting from the third side surfacein the transverse direction of the moving mechanism and a fourth wedgeprojecting from the fourth side surface in the transverse direction ofthe moving mechanism.
 5. The spinal implant of claim 4, wherein thefirst wedge includes a first upper contact surface and a first lowercontact surface, the second wedge includes a second upper contactsurface and a second lower contact surface, the third wedge includes athird upper contact surface and a third lower contact surface, thefourth wedge includes a fourth upper contact surface and a fourth lowercontact surface, and wherein the first and second upper contact surfacescontact the first proximal ramps and the first and second lower contactsurfaces contact the second proximal ramps, and wherein the third andfourth upper contact surfaces contact the first distal ramps and thethird and fourth lower contact surfaces contact the second distal ramps.6. The spinal implant of claim 4, wherein the first wedge includes afirst curved upper contact surface and a first curved lower contactsurface, the second wedge includes a second curved upper contact surfaceand a second curved lower contact surface, the third wedge includes athird curved upper contact surface and a third curved lower contactsurface, the fourth wedge includes a fourth curved upper contact surfaceand a fourth curved lower contact surface, wherein the first and secondcurved upper contact surfaces contact the first proximal ramps and thefirst and second curved lower contact surfaces contact the secondproximal ramps, wherein the third and fourth curved upper contactsurfaces contact the first distal ramps and the third and fourth curvedlower contact surfaces contact the second distal ramps, and wherein thefirst, second, third, and fourth curved upper surfaces and the first,second, third, and fourth curved lower surfaces are configured tofacilitate adjustment of the angle of inclination between the first andsecond endplates upon rotating the first set screw along the rotationaxis by enabling the respective curved surfaces to pivot on acorresponding ramp of the first and second proximal ramps and first andsecond distal ramps.
 7. The spinal implant of claim 4, wherein the firstand second wedges are configured to move along first and second inclinedcontact surfaces of the first and second proximal ramps, respectively,and wherein the third and fourth wedges are configured to move alongthird and fourth inclined contact surfaces of the third and fourthdistal ramps, respectively.
 8. The spinal implant of claim 7, whereinthe first inclined contact surfaces of the first proximal ramps areinclined with respect to the first inside surface of the first endplateand extend away from the first inside surface by a first inclineddistance and the second inclined contact surfaces of the second proximalramps are inclined with respect to the second inside surface of thesecond endplate and extend away from the second inside surface by asecond inclined distance, wherein the third inclined contact surfaces ofthe first distal ramps are inclined with respect to the first insidesurface of the first endplate and extend away from the first insidesurface by a third inclined distance and the fourth inclined contactsurfaces of the second distal ramps are inclined with respect to thesecond inside surface of the second endplate and extend away from thesecond inside surface by a second inclined distance, and wherein thefirst inclined distance is greater than the third inclined distance andthe second inclined distance is greater than the fourth inclineddistance thereby facilitating adjustment of the angle of inclinationbetween the first and second endplates upon rotating the first set screwalong the rotation axis.
 9. The spinal implant of claim 1, wherein eachramp of the first and second proximal ramps and first and second distalramps includes a corresponding contact surface, and wherein each guidewall of the first plurality of guide walls and each guide wall of thesecond plurality of guide walls extends in a parallel direction with atleast one ramp of the first and second proximal ramps and first andsecond distal ramps.
 10. The spinal implant of claim 1, wherein thefirst and second endplates are pivotable in a lateral direction thereofwith respect to the moving mechanism.
 11. The spinal implant of claim 1,wherein the first and second endplates are configured to promote bonegrowth therebetween.
 12. The spinal implant of claim 1, wherein thefirst and second endplates include a plurality of inclined apertures anda corresponding plurality of anchoring screws, each anchoring screwpassing through a corresponding inclined aperture and being configuredto anchor into a vertebral body.
 13. The spinal implant of claim 1,wherein the screw guide wall housing includes an aperture passingthrough the first proximal end of the first endplate and the secondproximal end of the second endplate, the aperture being configured toreceive a corresponding surgical tool having circumferential edgesextending in a longitudinal direction thereof, wherein thecircumferential edges are configured to selectively engage with thefirst set screw and second set screw in a first insertion position, andengage with only the second set screw in a second insertion position,wherein the corresponding surgical tool is configured to selectivelyrotate the first set screw and/or the second set screw along therotation axis.
 14. The spinal implant of claim 13, wherein the screwguide wall housing is further configured to receive the correspondingsurgical tool at an offset angle with respect to the rotation axis ofthe moving mechanism.
 15. The spinal implant of claim 1, wherein thefirst and second endplates each have a footprint configured for at leastone surgical technique chosen from: anterior surgical insertion andadjustment techniques, oblique surgical insertion and adjustmenttechniques, and lateral surgical insertion and adjustment techniques.16. The spinal implant of claim 15, wherein the moving mechanism isconfigured to: adjust the spacing between the first and second endplatesat the proximal end from 10 mm to 22 mm and adjust the spacing betweenthe first and second endplates at the distal end from 7 mm to 12 mm; andadjust the angle of inclination between the first and second endplateswithin an angular range from 7 degrees to 25 degrees.
 17. The spinalimplant of claim 1, wherein the moving mechanism is configured to:adjust the spacing between the first and second endplates at theproximal end from 9 mm to 16 mm and adjust the spacing between the firstand second endplates at the distal end from 9 mm to 16 mm; and adjustthe angle of inclination between the first and second endplates withinan angular range from 6 degrees to 11 degrees.
 18. The spinal implant ofclaim 1, wherein the first endplate has a concave surface profile withrespect to the moving mechanism and the second endplate has a convexsurface profile with respect to the moving mechanism.
 19. An interbodydevice deployable between a contracted position and an expandedposition, the interbody device comprising: a spinal implant, the spinalimplant having a longitudinal axis and a transverse axis perpendicularto the longitudinal axis, a proximal end and a distal end disposed onopposite ends of the spinal implant, and first and second lateralsurfaces disposed on opposite ends of the spinal implant, the spinalimplant comprising: a first endplate, the first endplate including afirst plurality of guide walls and a first plurality of inclined ramps,each guide wall of the first plurality of guide walls extending along aninside surface of the first endplate in a direction parallel to acontact surface of a corresponding inclined ramp of the first pluralityof inclined ramps; a second endplate, the second endplate including asecond plurality of guide walls and a second plurality of inclinedramps, each guide wall of the second plurality of guide walls extendingalong an inside surface of the second endplate in a direction parallelto a contact surface of a corresponding inclined ramp of the secondplurality of inclined ramps; a moving mechanism operably coupled to thefirst endplate and the second endplate and positioned therebetween, themoving mechanism including: a first trolley and a second trolleydisposed opposite the first trolley, the first and second trolleyshaving a plurality of projections and a plurality of wedges, eachprojection being configured to move along a corresponding guide wall ofthe first and second plurality of guide walls and each wedge beingconfigured to contact and move along a corresponding ramp of the firstand second plurality of ramps; a first set screw and a second set screwopposite the first set screw, the first set screw being operably coupledto the first trolley and the second set screw being operably coupled tothe second trolley, the first set screw and second set screw beingconfigured to rotate in a first direction and a second direction about arotation axis, the rotation axis projecting in a longitudinal directionof the moving mechanism in a parallel direction of the transverse axisof the spinal implant; and an adjustment aperture exposing internalcircumferential surfaces of the first and second set screws,respectively, wherein the first set screw is configured to move thefirst trolley in the longitudinal direction of the moving mechanism byrotation of the first set screw along the rotation axis and the secondset screw is configured to move the second trolley in the longitudinaldirection of the moving mechanism by rotation of the second set screwalong the rotation axis, wherein the moving mechanism is configured tooperably adjust a spacing between the first and second endplates uponsimultaneous rotation of the first and second set screws along therotation axis, and wherein the moving mechanism is configured tooperably adjust an angle of inclination between the first and secondendplates upon rotating the first set screw or second set screw alongthe rotation axis.
 20. A spinal implant system adjustable in situbetween vertebral bodies of a patient and deployable between acontracted position and an expanded position, the system comprising: aspinal implant having a longitudinal axis and a transverse axisperpendicular to the longitudinal axis, a proximal end and a distal enddisposed on opposite ends of the transverse axis, and first and secondlateral surfaces disposed on opposite ends of the longitudinal axis, thespinal implant comprising: a first endplate, the first endplateincluding a first plurality of guide walls and a first plurality ofinclined ramps, each guide wall of the first plurality of guide wallsextends along an inside surface of the first endplate in a directionparallel to a contact surface of a corresponding inclined ramp of thefirst plurality of inclined ramps; a second endplate, the secondendplate including a second plurality of guide walls and a secondplurality of inclined ramps, each guide wall of the second plurality ofguide walls extends along an inside surface of the second endplate in adirection parallel to a contact surface of a corresponding inclined rampof the second plurality of inclined ramps; a moving mechanism operablycoupled to the first endplate and the second endplate and positionedtherebetween, the moving mechanism including: a first trolley and asecond trolley disposed opposite the first trolley, the first and secondtrolleys having a plurality of projections and a plurality of wedges,each projection being configured to move along a corresponding guidewall of the first and second plurality of guide walls and each wedgebeing configured to contact and move along a corresponding ramp of thefirst and second plurality of ramps; a first set screw and a second setscrew opposite the first set screw, the first set screw being operablycoupled to the first trolley and the second set screw being operablycoupled to the second trolley, the first set screw and second set screwbeing configured to rotate in a first direction and a second directionabout a rotation axis, the rotation axis projecting in a longitudinaldirection of the moving mechanism in a parallel direction of thetransverse axis of the spinal implant; and an adjustment apertureexposing internal circumferential surfaces of the first and second setscrews; a first surgical tool having a circumferential surface thatcorresponds to the internal circumferential surfaces of the first andsecond set screws, the first surgical tool being configured toselectively rotate the first set screw when inserted therein and rotatethe first and second set screws when inserted therein, wherein the firstset screw is configured to move the first trolley in the longitudinaldirection of the moving mechanism by rotation of the first set screwalong the rotation axis and the second set screw is configured to movethe second trolley in the longitudinal direction of the moving mechanismby rotation of the second set screw along the rotation axis, wherein themoving mechanism is configured to operably adjust a spacing between thefirst and second endplates upon simultaneous rotation of the first andsecond set screws along the rotation axis, and wherein the movingmechanism is configured to operably adjust an angle of inclinationbetween the first and second endplates upon rotating the first set screwor second set screw along the rotation axis.
 21. An expandable spinalimplant deployable between a contracted position and an expandedposition, comprising: a first endplate, the first endplate including: afirst outside surface and a first inside surface opposite the firstoutside surface, the first inside surface including a first plurality ofguide walls, first proximal ramps and first distal ramps disposedopposite the first proximal ramps; a second endplate, the secondendplate including: a second outside surface and a second inside surfaceopposite the second outside surface, the second inside surface includinga second plurality of guide walls, second proximal ramps and seconddistal ramps disposed opposite the second proximal ramps; a screw guideendplate operably coupled to the first endplate and second endplate, thescrew guide endplate including at least one aperture configured toselectively receive at least one corresponding anchoring screw therein;a moving mechanism operably coupled to the first endplate, the secondendplate, and the screw guide endplate, the moving mechanism beingpositioned between the first endplate and second endplate, the movingmechanism including: a buttress block and a first trolley and a secondtrolley disposed on opposite sides of the buttress block, a screw guidewall housing a rotatable first set screw and a rotatable second setscrew axially aligned with the first set screw, the first set screwbeing operably coupled to the first trolley and the second set screwbeing operably coupled to the second trolley, wherein the first trolleyand second trolley are configured to selectively act against the firstand second plurality of guide walls, first and second proximal ramps,and first and second distal ramps upon rotation of at least one of thefirst set screw and second set screw, wherein the moving mechanism isconfigured to operably adjust a spacing between the first and secondendplates upon simultaneous rotation of the first and second set screwsalong a rotation axis thereof, and wherein the moving mechanism isconfigured to operably adjust an angle of inclination between the firstand second endplates upon rotating the first set screw or second setscrew along the rotation axis.
 22. The expandable spinal implant ofclaim 21, wherein the screw guide endplate further comprises a pluralityof apertures including the at least one aperture, wherein each apertureis configured to selectively receive at least one correspondinganchoring screw therein.
 23. The expandable spinal implant of claim 21,wherein the screw guide endplate and moving mechanism are configuredsuch that the moving mechanism can selectively adjust a spacing betweenthe first and second endplates and adjust an angle of inclinationbetween the first and second endplates while the at least onecorresponding anchoring screw is anchored within a correspondingvertebrae.
 24. The expandable spinal implant of claim 21, wherein the atleast one aperture is configured to orient one corresponding anchoringscrew in either of a first orientation or a second orientation, thefirst orientation aligning the one corresponding anchoring screw suchthat it projects through a corresponding slotted portion of the firstendplate, the second orientation aligning the one correspondinganchoring screw such that it projects through a corresponding slottedportion of the second endplate.
 25. The expandable spinal implant ofclaim 21, wherein the at least one aperture is configured to receive onecorresponding anchoring screw therein and orient the correspondinganchoring screw to project through a corresponding recess in acorresponding one of the first endplate or second endplate.
 26. Theexpandable spinal implant of claim 21, further comprising a plurality ofapertures including the at least one aperture, wherein each aperture isconfigured to receive one corresponding anchoring screw therein andorient the corresponding anchoring screw to project through acorresponding recess in a corresponding one of the first endplate orsecond endplate.